Loop Diuretics in the Treatment of Hypertension
Overview
Authors
Affiliations
Loop diuretics are not recommended in current hypertension guidelines largely due to the lack of outcome data. Nevertheless, they have been shown to lower blood pressure and to offer potential advantages over thiazide-type diuretics. Torsemide offers advantages of longer duration of action and once daily dosing (vs. furosemide and bumetanide) and more reliable bioavailability (vs. furosemide). Studies show that the previously employed high doses of thiazide-type diuretics lower BP more than furosemide. Loop diuretics appear to have a preferable side effect profile (less hyponatremia, hypokalemia, and possibly less glucose intolerance). Studies comparing efficacy and side effect profiles of loop diuretics with the lower, currently widely prescribed, thiazide doses are needed. Research is needed to fill gaps in knowledge and common misconceptions about loop diuretic use in hypertension and to determine their rightful place in the antihypertensive arsenal.
Structural basis for human NKCC1 inhibition by loop diuretic drugs.
Zhao Y, Vidossich P, Forbush B, Ma J, Rinehart J, De Vivo M EMBO J. 2025; 44(5):1540-1562.
PMID: 39875725 PMC: 11876703. DOI: 10.1038/s44318-025-00368-6.
A Unique Case of a Mildly Symptomatic Patient With Severe Hypokalemia Secondary to Furosemide.
Dao K, Dhillon A, Uddin S, Eppanapally S, Lai H J Investig Med High Impact Case Rep. 2024; 12:23247096241300932.
PMID: 39568096 PMC: 11580096. DOI: 10.1177/23247096241300932.
Repurposing antihypertensive drugs for pain disorders: a drug-target mendelian randomization study.
Du K, Li A, Zhang C, Li S, Chen P Front Pharmacol. 2024; 15:1448319.
PMID: 39268473 PMC: 11390634. DOI: 10.3389/fphar.2024.1448319.
Hyponatremia in geriatric patients.
Djukic M, Grewe J, Kunz O, Gross O, Nau R Z Gerontol Geriatr. 2024; 58(1):40-45.
PMID: 39143233 DOI: 10.1007/s00391-024-02342-z.
Zhao Y, Schubert H, Blakely A, Forbush B, Smith M, Rinehart J Nat Commun. 2024; 15(1):7006.
PMID: 39143061 PMC: 11324901. DOI: 10.1038/s41467-024-51381-y.