$Unique_ID{BRK01160} $Pretitle{} $Title{Disagreement on the Question of Water Pills} $Subject{hypertension water pill cholesterol diuretics diuretic pills fat fats lipids blood lipoproteins HDL beta blockers angiotensin converting enzyme inhibitors ACE insulin medicine medicines medications medication high density cholesterol diabetic diabetics diabetes mellitus} $Volume{G-7,R-4} $Log{ Causative Factors of Hypertension*0009601.scf} Copyright (c) 1991-92,1993 Tribune Media Services, Inc. Disagreement on the Question of Water Pills ------------------------------------------------------------------------------ QUESTION: I have been on medicine for my hypertension for a long time. It's 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? ------------------------------------------------------------------------------ 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 situations 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. ---------------- 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.