Hemorrheologic effect of diuretics in the control of blood pressure in the hypertensive patient
Keywords:
Hypertension, Nitric Oxide, Blood Pressure, Blood viscosityAbstract
Background: Diuretics are the first choice as an antihypertensive, because of its efficacy and cost, however its mechanism of action is not well understood. The aim of this work was to analyze the hemorrheological effect of the diuretics as vasodilators in patients with newly diagnosed arterial hypertension.
Methods: Patients with hypertension were given diet and exercise recommendations and 25 mg of chlorthalidone per day were prescribed; Hemoglobin/hematocrit, viscosity, and basal nitric oxide (ON) were determined at 15 and 45 days and compared with healthy subjects.
Results: We included 28 patients with average age of 48 years old; systolic blood pressure in the treated patients decreased from baseline at 15 days from 130 to 119 mm Hg and at 114 mm Hg at 15 to 45 days; diastolic blood pressure decreased from baseline at 15 days from 103 to 97 mm Hg, and at 93 mm Hg at 15 to 45 days. The hematocrit increased in both men and women with a statistical significance of the baseline period at 15 days, after that, it remained without significative changes. The viscosity increased similarly to the hematocrit, which conditioned the ON elevation.
Conclusions: The increase in hematocrit due to diuretic caused an increase in blood viscosity, which led to an increase in nitric oxide, resulting in lower blood pressure.
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References
Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortality. Lancet 2002; 360:1903-1913.
Gutiérrez JP, Rivera-Dommarco J, Shamah-Levy T, Villalpando-Hernández S, Franco A, Cuevas-Nasu L. Encuesta Nacional de Salud y Nutrición 2012. Resultados Nacionales. Cuarnavaca, Morelos: Instituto Nacional de Salud Pública; 2012.
The Trials of Hypertension Prevention Collaborative Research Group. Effect of weight loss and sodium reduction intervention on blood pressure and hypertension incidence in overweight people with high-normal blood pressure. Arch Intern Med 1997;157:657-667.
Psaty BM, Smith NL, Siscovick DS, Koepsell TD, Weiss NS, Heckbert SR, et al. Health outcomes associated with antihypertensive therapies used as first-line agents. JAMA. 1997;277(9):739-745.
The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic. JAMA. 2002;288:2981-2997.
Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and treatment of high Blood Pressure. JAMA. 2003;289:2560-2572.
Dustan HP, Tarazi RC, Bravo EL. Diuretic and diet treatment of hypertension. Arch Intern Med. 1974;133:1007-1013.
Schloz PM, Karis JH, Gump FE, Kinney JM, Chien S. Correlation of blood rheology with vascular resistance in critically ill patients. J Appl Physiol. 1975;39(6):1008-1011.
Chien S. Blood rheology in hypertension and cardiovascular disease. Cardiovasc Med. 1977;2:356-360.
Letcher RL, Chien S, Pickering TG, Sealey JE, Laragh JH. Direct relationship between blood pressure and blood viscosity in normal and hypertensive subjects. Am J Med. 1981;70(6):1195-1202.
Hultgren HN. Reduction of systemic arterial blood pressure at high altitude. Hypoxia, high altitude and heart. New York: Karger Publishers; 1970.
Tsai AG, Acero PR, Nance P, Cabrales JA, Frangos JA, Buerk DG, Intaglietta M. Elevated plasma viscosity in extreme hemodilution increase perivascular nitric oxide concentration and microvascular perfusion. Am J Physiol Heart Circ Physiol. 2005;288:H17830-1739.
Martini J, Carpentier B, Chávez-Negrete A, Cabrales P, Tsai AG, Intaglietta M. Beneficial Effects due to Increasing Blood and Plasma Viscosity. Am J Physiol Heart Circ Physiol. 2005;289:H2136-H2143.
Cooke JP, Singer AH, Tsao P, Zera P, Rowan RA, Billingham ME. Antiaterogenic effect of L-Arginine in hypercholesterolemic rabbit. J Clin Invest. 1992;90:1168-1172.
Kubes PM, Suzuki M, Granger DN. Nitric oxide: an endogenous modulator of leukocyte adhesion. Proc Natl Acad Sci USA. 1991;88(11):4651-4655.
Wells RE, Denton R. Merril EW. Measurement of viscosity of biologic fluids by cone plate viscometer. J Lab Clin Med. 1961;57:646-656.
Gress LC, Wagner DA, Glogowski J, Skipper PL, Wishonok JS, Tannenbaum SR. Analysis of nitrate, nitrite and nitrate in biological fluids. Ann Biochem Pharmacol. 1982;126:131-138.
Letcher RI, Chien S, Pickering TG, Sealey JE, Laragh JH. Direct relationship between blood pressure and blood viscosity in normal and hypertensive subjects. JAMA. 1981;70:1195-1202.
Emery AC Jr, Whitcomb WH, Frohlich ED: “Stress” polycythemia and hypertension. JAMA. 1974;229:159-162.
Vanhoutte PM. The endothelium-modulator of vascular smooth-muscle tone. N Engl J Med. 1988;319:512-513.
Furchgott RF, Zawadski JV. The obligatory role of endothelial cells in the relaxation of arterial smooth muscle by acetylcholine. Nature. 1980;288:373-376.
De Simone G, Devereux RB, Chilani M, Best LG, Lee ET, Welty TK. Association of Blood pressure with blood viscosity in American Indians: the Strong Heart Study. Hypertension. 2005;45(4):625-30.
Chávez NA, Frati MA, Amato DM, Argüero RS. Hemodilución de gran volumen en la eritrocitosis secundaria. Rev Med IMSS. 1987;25:47-52.
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