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From: werner@aecom.UUCP (Craig Werner)
Newsgroups: net.med
Subject: Re: Thiazide diuretics & blood lipid level
Message-ID: <2055@aecom.UUCP>
Date: Fri, 15-Nov-85 13:49:17 EST
Article-I.D.: aecom.2055
Posted: Fri Nov 15 13:49:17 1985
Date-Received: Sat, 16-Nov-85 07:27:37 EST
References: <547@nbires.UUCP>
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Organization: Albert Einstein Coll. of Med., NY
Lines: 35

>   First I wonder if anyone knows what the normal values for these items
> are and what is considered too high.  This might help in guessing whether
> 5 or 10% rises are significant.

	Normal is actually too high. It varies from lab to lab. And since
risk in directly (and exponentially) related to blood levels, any increase
is significant.

>   Third if Steve has a reference for the increase blood lipid findings I'd
> really like to get it.
	It's in the package insert (and required to be there) on all drugs that
it is associated with, also on all the ads in Medical Journals.  Not to
mention the PDR and Merck manual, which Steve Dyer is exquisitely consistent in
consulting.
	There are now coming on the market several brands of diuretics that
do not raise lipids at all, and will be many more if they sell well.

>   Fourth a friend of mine told me that she had heard that diuretic use had
> recently been associated with an increased risk of heart attack even
> when compared with no treatment at all. I don't believe it but I wonder
> if there has been any finding like this.  

	To repeat, according to MRFIT, Diuretic use in patients with 
borderline hypertension (90-95 diastolic) and existing cardiac arrythmias
(EKG abnormalities) can aggravate this and lead to an increased risk of
sudden death. The mechanism is loss of Potassium with the Sodium.  These
patients should be (and are) put on Potassium-sparing diuretics instead.
If no such electrical abnormality exists, then there is no risk.  Or, if
blood pressure is higher, the risk of BP complication far exceeds the added
risk (which is now avoided in current practice -- after all, doctors read
these studies too, you know.)



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