Patient's Query
Hello doctor,
I am a hypertensive 31-year-old. My ECG and TMT are normal, and my echocardiogram shows mild concentric left ventricular hypertrophy (LVH). I am currently taking Telmisartan/Amlodipine (80/5) at night and Amlodipine/Hydrochlorothiazide (5/12.5) in the morning. Hydrochlorothiazide (HCTZ) was started one month ago. After monitoring, my sodium and potassium levels are normal, but my uric acid levels are trending upwards. Instead of HCTZ, can I switch to Spironolactone? I also feel I have very mild edema, possibly induced by Amlodipine, as I am taking 10 mg daily.
Previously, despite being on Telmisartan and Amlodipine, my blood pressure was high, but once HCTZ was added, it worked perfectly for me. My current blood pressure is in the range of 120/80, so I do not want to discontinue the diuretic. One of my medical friends suggested that Spironolactone could be introduced, as it has no effect on uric acid—correct? I would appreciate your guidance on this matter.
Hello,
Welcome to icliniq.com.
I agree with you that Hydrochlorothiazide increases uric acid levels, while Amlodipine may contribute to leg swelling (peripheral edema). Regarding this, Spironolactone can be added to your therapy, but it has a relatively weak antihypertensive effect and may lead to elevated potassium levels. For this reason, it is important to regularly check potassium levels while taking Spironolactone.
If your blood pressure remains high while on Spironolactone, I would recommend adding Moxonidine to your treatment regimen. You should discuss these treatment options with your doctor.
I am here to help if you have any further questions.
Patient's Query
Hello doctor,
Thanks a lot for your response.
You mentioned that Spironolactone may increase potassium levels and is a weak antihypertensive drug. What is Spironolactone primarily used for? Since HCTZ increases uric acid, is there a diuretic that has little or no effect on uric acid? I am looking for a diuretic that does not affect uric acid levels.
You also mentioned that Moxonidine can be added. What class does Moxonidine belong to, and when is it recommended? Is it safe enough for long-term use, like ARBs (angiotensin II receptor blockers) and CCBs (calcium channel blockers)?
Hello,
Welcome back to icliniq.com.
Spironolactone is used to conserve potassium, especially when combined with diuretics that lower potassium levels, primarily in cases of heart failure. Another diuretic, Furosemide (Lasix), does not increase uric acid levels and is effective against peripheral edema. Moxonidine is a central antihypertensive drug and is considered safe for long-term use.
Patient's Query
Hello doctor,
Thanks a lot for your response.
I hope I am not disturbing you at this hour. From what you mentioned, the diuretics that have less or no effect on uric acid are Spironolactone and Furosemide (Lasix). Am I correct? Can Lasix be used for blood pressure or edema issues? Is it generally prescribed for blood pressure? Is Lasix an alternative to thiazide diuretics?
Since I am already using Telmisartan and Amlodipine for blood pressure, what third agent would you recommend for my case? Here is a brief summary of my medical history: no diabetes, normal thyroid function, normal electrolytes, and normal liver and kidney function tests. I do have the Hb E trait, which I inherited from my mom, and I lead a slightly stressful life. There are no other abnormalities.
Hello,
Welcome back to icliniq.com.
You are not disturbing me at all. Regarding diuretics, Furosemide may have some implications for uric acid levels. It can be used for high blood pressure or edema. For long-term treatment, I would recommend using Torasemide (instead of Furosemide or Moxonidine), as it has fewer adverse effects compared to other diuretics. Torasemide is effective in reducing edema and lowering blood pressure. I suggest starting with a low dose and gradually increasing it to 10 mg daily.
I would also recommend reducing the dose of Amlodipine and potentially discontinuing it to help alleviate leg swelling. Given your young age, high blood pressure is exceptional, so I would recommend performing some tests to investigate other possible causes of elevated blood pressure. These tests may include fasting glucose, kidney and liver function tests, blood electrolytes, cortisol, and aldosterone plasma levels for potential adrenal gland dysfunction, thyroid hormone levels for possible thyroid dysfunction, and a renal artery angiography CT (computed tomography) scan for fibromuscular dysplasia.
You should discuss these tests with your doctor.
Kind regards.
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Answered byDr. Ilir Sharka
Medically reviewed byDr. K. Shobana
Same symptoms don't mean you have the same problem. Consult a doctor now!
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