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Hypertension and potassium-sparing diuretics

High blood pressure and potassium-sparing diuretics

Potassium-sparing diuretics belong to a group of drugs which stimulate the production of urine without causing a loss in potassium.

These diuretics have been developed because the human body is less well protected for sodium losses.

It is counteracted an effect of aldosterone (forming a part of the urinary system, namely the collecting pipe) by blocking its receptor.

Potassium-sparing diuretics are used inter alia in hypertension to lower blood pressure, but also on water retention in the tissue with associated cardiac dysfunction (heart failure to congestive heart failure, renal dysfunction or damage to the liver, each with strong water retention).

Groups and drug names

Potassium-sparing diuretics include two different groups of drugs with different chemical structures and different mechanisms of action.

The absorption of sodium is inhibited by the active ingredients of the drugs amiloride and triamterene which are sold under the name of Midamor® and Dyrenium®.

Triameteren as potassium-sparing diuretics

Potassium-sparing diuretics bring help in Hypertension

In hypertensive one caliumssparendes diuretics is often prescribed by doctors

Spironolactone (Aldactone® and Osyrol®) is a synthetic steroid and a prodrug.

Canrenone is the active metabolite. This acts on the receptor for aldosterone antagonistic. Canrenone is also available as a medicine, in pure form or as potassium canrenoate, a salt (Aldactone per Injectione®). Eplerenone (Inspra®) is a spironolactone analogue with an increase in the selectivity for aldosterone.

Indications for potassium-sparing diuretics

To prevent potassium deficiency, amiloride and triamterene can be used in conjunction with other diuretics such as thiazides and loop diuretics. The reason lies in the limited efficacy of amiloride.

Triamterene is also used for the treatment of existing heart failure, cirrhosis of the liver and edema,  if the cause is secondary hypertension.

In connection with Thiazedin, amiloride may be prescribed for hypertension.

Aldosterone antagonists are preferred and used with proven effects in both primary and secondary hypertension.

They can sometimes lead to potassium deficiency, high blood pressure (hypertension), heart failure, liver cirrhosis and nephrotic syndrome, as well as cardiovascular diseases, including the treatment of hypertension (high blood pressure).

The latter leads to an increase in aldosterone blood levels, but the affected heart muscle cells play an important role with respect to the fibres in the heart muscle and blood vessels.

This applies equally well with a reduced availability of nitric oxide with a vasodilating effect.

The metabolism of triamterene and spironolactone is limited in liver disease.

Modes of action

Potassium-sparing diuretics are often used for hypertension

When used for high blood pressure treatment, diuretics are often used in combination with other antihypertensive agents such as ACE inhibitors, beta-blockers and calcium channel blockers.

The blood pressure drops, because there is a reduction of circulating blood due to increased water excretion. Thus, this leads to a decrease in the pressure in the vessels, and ultimately the blood pressure falls.

Aldosterone acts by binding to an intracellular receptor. This aldosterone receptor complex leads to an increased synthesis of the channels of sodium and potassium.

The so-called aldosterone antagonists block the intracellular aldosterone bringing the number of channels down.

Potassium-sparing diuretics in hypertension

Urinary water and sodium remain in the body. This results in a slightly increased excretion of sodium and water.

An action can only be made if aldosterone is present. Thus, the ineffectiveness of potassium-sparing diuretics after an adrenalectomy (removal of the adrenal gland) remains high.

The effect of triamterene and amiloride is due to a blockage of the epithelial sodium channel independent of the presence of aldosterone.

Thus, the uptake of sodium ions occurs in the tubule cells. As a result, the urine is retained in concentrated form and it is due to osmosis and increased water excretion. The passive form of excretion of potassium ions almost comes to a complete standstill.

The reason is that the sodium-potassium pump cannot absorb potassium ions because of the lack of sodium. In addition, the excretion amount of magnesium ions and active excretion of hydrogen ions decreases (protons).

Here you can read more about the loop diuretics and their use in high blood pressure.




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