$Unique_ID{BRK01160}
$Pretitle{Circulatory System}
$Title{Disagreement on the Question of Water Pills}
$Subject{hypertension water pill cholesterol}
$Volume{G-3}
$Log{}

Copyright (c) 1991   Tribune Media Services, Inc.


Disagreement on the Question of Water Pills


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QUESTION:  I have been on medicine for my hypertension for a long time.  Its a
pill called a water pill, and my old doctor was satisfied with the results.
Since moving, and changing physicians, I am now advised to use another
medication because these pills raise cholesterol and could be bad for me
according to my new doctor.  Do you have an opinion about this?

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ANSWER:  I have opinions about most things, but unfortunately, according to my
wife, they are not always correct.  On the question of diuretics (that's a
fancier name for water pills) however, there is much controversy and
disagreement.  According to recent studies it does seem clear that diuretics
have a negative effect on fats (lipids) in the blood and will raise the level
of cholesterol as well as the low density lipoproteins (the "bad" ones) while
not increasing HDL cholesterol (the "good" ones). In addition, diuretics seem
to lower insulin sensitivity which could increase the risk of developing
diabetes in some individuals.  However physicians with a favorable opinion
about diuretics claim that there is no proof that the effects on cholesterol
remain true over the long haul, or that the changes in insulin sensitivity are
clinically significant.  Many physicians believe that the newer medications
for hypertension, beta blockers, calcium channel blockers and
angiotensin-converting enzyme inhibitors (ACE inhibitors for short) are
medications that should be used in the initial treatment of the condition.
And there is good proof to support that position as well.  In individual
cases, it is the personal history and physical condition of the patient, that
may lead the physician to consider the use of one type of medication over the
other.  It may be unwise to use a diuretic in a patient who already has an
elevated cholesterol, or is a diabetic depending upon insulin to manage that
condition.  As in so many situation in medicine, it takes a complete knowledge
about the patient, and concern for their well being to make a decision of this
nature.  I would talk it over with your new doctor, find out why he is
advising a change in a medication you seem to be satisfied with, and then
participate in the decision based upon your new knowledge.
ÿ
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The material contained here is "FOR INFORMATION ONLY" and should not replace 
the counsel and advice of your personal physician.  Promptly consulting your 
doctor is the best path to a quick and successful resolution of any medical 
problem.
