Blood pressure and Diuretics

[H.Frank Beshear]

I've taken bp meds for several years, currently Prinivil, norvasc, and triam/hctz for a diuretic. The triam is making me pretty Sun sensitive, even with a sunscreen I get really dark. I've already had one go round with a skin cancer don't need another. I asked my Doc about a water pill that wouldn't deplete potassium, or be sun sensitive and he prescribed Lasix, which depletes potassium :crap: . Is there a better diuretic available? My doc's a good guy but he doesn't always understand how much time I spend outside. Thanks, Frank

[maryluke]

I sell BP meds to physicians and most all diuretics will deplete your potasium. The key is to take HCTZ with another BP medicine that causes your body to retain potasium and the 2 meds together will help balance yourpotasium. The BP meds that make your body retain potasium are any that work in the RAAS (renin aldosterone angiotensin system) and these are ACE inhibitors, which are great drugs, have a lot of data behind them, and are generic and cheap, but most will cause you to have a dry cough. The Ace inhibitors are commonly prescribed with HCTZ ( ACE/HCTZ) Another popular class is the ARB class, which I sell and have been around for 10 years. I sell Diovan/ HCTZ which is the #1 prescribed ARB and has proven heart benefits. It is the cardiologist #1 choice. You will get equivalent blood pressure reductions to the ACE inhibitors without the dry cough that is associated with ACE inhibitors. Diovan now haves a combination pill that includes the HCTZ, so you only have to take one pill, it is called Diovan HCT. The main drawback to Diovan HCT is that it is not generic and it costs about $100 month. But it has the best managed care coverage and if you havee good insurance it will cost you about $15 month. If you have good insurance , I would go with Diovan/HCT and you will avoid the dry hacking cough. If you are paying cash I would try ACE/HCTZ, which can be had at WAL-Mart for $4 month, but you may get the dry cough, the rate of cough for ACE are about 30-40% I hope this helps

[H.Frank Beshear]

I'm actually more concerned about the sun issues, I can always supplement the potassium if I need to. My job and hobbies are all outdoor though. Thanks for the suggestions though.

[CNY rider]

I sell BP meds to physicians and most all diuretics will deplete your potasium. The key is to take HCTZ with another BP medicine that causes your body to retain potasium and the 2 meds together will help balance yourpotasium. The BP meds that make your body retain potasium are any that work in the RAAS (renin aldosterone angiotensin system) and these are ACE inhibitors, which are great drugs, have a lot of data behind them, and are generic and cheap, but most will cause you to have a dry cough. The Ace inhibitors are commonly prescribed with HCTZ ( ACE/HCTZ) Another popular class is the ARB class, which I sell and have been around for 10 years. I sell Diovan/ HCTZ which is the #1 prescribed ARB and has proven heart benefits. It is the cardiologist #1 choice. You will get equivalent blood pressure reductions to the ACE inhibitors without the dry cough that is associated with ACE inhibitors. Diovan now haves a combination pill that includes the HCTZ, so you only have to take one pill, it is called Diovan HCT. The main drawback to Diovan HCT is that it is not generic and it costs about $100 month. But it has the best managed care coverage and if you havee good insurance it will cost you about $15 month. If you have good insurance , I would go with Diovan/HCT and you will avoid the dry hacking cough. If you are paying cash I would try ACE/HCTZ, which can be had at WAL-Mart for $4 month, but you may get the dry cough, the rate of cough for ACE are about 30-40% I hope this helps


Spoken like a true drug sales rep!
Care to add just how many patients out of 100 taking ACE inhibitors get a clinically signficant cough?
What about the cost to our society of having millions of patients with hypertension taking really expensive ARB's while they could take really cheap older drugs?
Does the fact that the insurance company pays mean that the money is just conjured out of thin air? That it's not ultimately extracted from the pockets of those paying insurance premiums?

[hansolo758]

I've taken bp meds for several years, Prinivil, norvasc, and triam/hctz for a diuretic. The triam is making me pretty Sun sensitive, even with a sunscreen I get really dark. I've already had one go round with a skin cancer don't need another. I asked my Doc about a water pill that wouldn't deplete potassium, or be sun sensitive and he prescribed Lasix, which depletes potassium :crap: . Is there a better diuretic available? My doc's a good guy but he doesn't always understand how much time I spend outside. Thanks, Frank

Triamterene is actually a potassium-sparing diuretic. Others include Spironolactone and Eplerenone; to my knowledge, they don't cause photosensitivity. Maryluke has a point; perhaps you don't need another diuretic as much as you might need a different kind of anti-hypertensive.

[rpm]

I take the HCTZ/Diovan combo, and I think it's excellent. I also have issues with the sun because I have a suppressed immune system. What kind of sunblock are you using? To get really effective coverage, you need to get one with zinc oxide in it. Here's my favorite, developed by the Mayo Clinic:

http://www.psico.com/products/vani_sunscreen_sport.cfm

The Vanicream sunblock is pasty white when it goes on, but it's quickly absorbed and has nothing in it to irritate.

I just had a basal cell removed, and I'm now visiting my dermatologist every six months, just like my dentist. I could bundle up like Michael Jackson or stay indoors all the time, but that's a crummy way to live. I'd rather take keep enjoying the outdoors and going to the doctor often enough that we can catch any bad things in their earliest stages.

[2LeftCleats]

You might get by without a diuretic if doses of either or both of the others are increased to compensate. Norvasc tends to cause swelling though so a diuretic may be important. If you stay with Lasix, it will be necessary to have your potassium level checked periodically. It does tend to lose potassium but the prinivil would at least partially counteract that effect. Aldactone (spironolactone) is one that might spare potassium but you run a small risk of elevated potassium so that would need to be checked still. I'm not aware that it causes sun sensitivity. You can get plain triamterene separate from hydrochlorothiazide and I don't believe it is likely to cause sun sensitivity either.

Whether or not you're taking a diuretic, with your significant sun exposure, you should be using a potent sunblock.

I'm in total agreement with CNY. I get plenty of unsolicited information about expensive drugs in my office. This forum is/was my refuge from all that. There is no reason to switch from your current medications--which are generics and apparently serve you well--to an expensive namebrand which would provide minimal if any benefit to you.

[bigbill]

I take BP meds and was Diovan for years. I am in the military and a doctor switched me to Maxide (sp?) which is a diuretic. It severely dehydrated me and I could never seem to stay hydrated. Finally a different doctor tried to put me back on Diovan and it was no longer carried by the military pharmacy. I now take Losartan (brand name Cozaar) with excellent results. I started taking it while still stationed in Hawaii and throughout my time in Sardinia with no sun exposure issues. I haven't had any side affects and my b/p stays around 120/75. Without meds I am 135/90.

[gasman]

Spoken like a true drug sales rep!
Care to add just how many patients out of 100 taking ACE inhibitors get a clinically signficant cough?
What about the cost to our society of having millions of patients with hypertension taking really expensive ARB's while they could take really cheap older drugs?
Does the fact that the insurance company pays mean that the money is just conjured out of thin air? That it's not ultimately extracted from the pockets of those paying insurance premiums?

+1

[malcolm]

ACE inhibitor cough (Vasotec cough) is fairly rare easy to dx and goes away if you stop the offending agent. Unless you need a diuretic, for active people the ACE inhibitor is probably a better choice for BP control if it works for you. Less effect on performance. It is usually the first choice of a sports med guy I know for BP in athletes.

[thwart]

Hey... lay off MaryLuke. He's a good guy.

Seriously, though, I agree about the problem with the latest/greatest (and... oh, yeah... most expensive) push that tends to propel our cost of health care upward. Someone, somewhere, somehow is footing the bill. And, eventually, it costs all of us.

I'd also agree that if you have significant issues with photosensitivity while taking thiazide diuretics an ACE inhibitor like lisinopril would be a good choice.

[DukeHorn]

Tough call. Complaining about drug prices is like complaining about the cost of R&D.

Think about all those stem cell companies (and academics) trying to come out with cell therapies. You think that research is cheap, especially with StemCells, Inc marketing some new medium for over $800/liter?

I'd like to cut down more on all the cash burned on fancy dinners for doctors by drug reps, but the marketing department usually wins over the research and development budget.

And QA and QC isn't cheap.

[H.Frank Beshear]

I'm already taking an ACE inhibitor (Prinivil aka Lisinopril) as well as a calcium channel blocker (Norvasc) and a diuretic Triam/HCTZ. Just checked and pressure is 123/76 so the meds are doing what they are supposed to do. I really don't need new BP drugs I need a new diuretic that doesn't have the issues of being photosensitive or deplete potassium. Sounds like I may not have that option, but if someone else wants to take a crack at it I'd appreciate the info. Don't be to hard on MaryLuke I've got a couple friends that sell drugs as well :D .

[2LeftCleats]

I gave you a couple of options--see above.

[maryluke]

Spoken like a true drug sales rep!
Care to add just how many patients out of 100 taking ACE inhibitors get a clinically signficant cough?
What about the cost to our society of having millions of patients with hypertension taking really expensive ARB's while they could take really cheap older drugs?
Does the fact that the insurance company pays mean that the money is just conjured out of thin air? That it's not ultimately extracted from the pockets of those paying insurance premiums?


As I mentioned above ace inhibitors are great drugs, they are the first line choice for all of the physicians I call on. They have the most protective data out there. The incidence of cough is between 30-40%, and that has been documented over and over again. The cough in most cases does not go away, the patient just gets used to it or they just live with it. Also ask any physician and they will tell you that ACE inhibitors are their first choice and that they only prescribe ARBS when patients can not tolerate an ACE inhibitor, I know this and they know this and that is where we position our products. All I did was try to help someone who had a question , there was no need for you to be such a turd

[CNY rider]

I If you have good insurance , I would go with Diovan/HCT.....snipped


I think it's pretty clear what you were suggesting.
People can read your post and decide for themselves.

[maryluke]

I think it's pretty clear what you were suggesting.
People can read your post and decide for themselves.

Coming from personal experience, Both of my parents were on ACES for 5 years back when they were not generic , and they both lived with that dry cough for 5 years, when ARBS came out , they were both switched over to equivalent doses of ARBS and they both got the equivalent BP reductions without the cough. I have nothing to gain from someone on the other side of the country using one of my companies products. Most managed care companies will not reimburse an ARB unless the physician provides documented proof that the patient has failed on an ACE, this is also well documented and well known, ask any of your physician friends. I like to ride, and if I had high blood pressure, the last thing I would want is a dry hacking cough. Again why you chose to make it a personal attack on what I do for a living, I have no idea, all I had tried to do was help someone who had a question

[Tom Byrnes]

Maryluke,

I take BP medication and found your post very informative. Thank you.

Tom

[Elefantino]

I was one who took an ACE and had the dry cough.

I've gone through a number of different combinations. Now I'm on a combination of Avalide/Norvasc and it doesn't seem to be working all that well. (130/high 80s) I am also dehydrated.

Had a bettery of tests done last week; see doc on Friday. Kidney specialist.

[H.Frank Beshear]

Hope all is well Mike, I had the kidney test done last year.

I started this thread because I was taking a drug that works well but makes me sensitive to sun. I asked because my doctor prescribes a med that depletes potassium and I've found out can be sun sensitive. I was hoping that someone would have a suggestion I could take back to my doc and for an alternative. I'm calling the doc this morning and having a little "chat" about what I want and don't want and Lasix is not an option. I used a drug prior to this that was potassium depleting and I had cramps and dehydration when I did longer rides. Not interested in tying that again. Best suggestion so far is a new sunscreen and that's the route I'll go for now I think. Fortunately I don't have the dry cough, but I also thought that MaryLukes ideas were good. Thanks all.

[H.Frank Beshear]

I think it's pretty clear what you were suggesting.
People can read your post and decide for themselves.

It was my post and my question. at least MaryLuke made an attempt to help, and answer my question not just attack someone else who's point of view you don't happen to agree with, seems we've had plenty of that this year with mixed results. Enjoy the day. Frank

[jmr986]

Again why you chose to make it a personal attack on what I do for a living, I have no idea, all I had tried to do was help someone who had a question[/QUOTE]

I found your information quite informative. I am on ACE and a diuretic. always looking for more info. Thank you. I guess we all have bad days.

[Dekonick]

I found this thread to have lots of useful information.

Frank, try long sleeve shirts too. There is a guy who rides around my neck of the woods who is covered head to toe (he is known as 'socks' to many) and he manages even in the hot, humid, nasty Maryland summers.

Cancer sucks - glad you are taking proactive steps to keep it at bay...

:)