Information has passed that rheumatologists are canceling what cardiologists have prescribed to lower blood pressure in order to preserve what is left of the joints.
This, of course, is stupidity in the style of my provocative article. on the abolition of antihypertensive drugs. The meaning is exactly the same - people are tired of pressure pills, and they want to refuse them. Swollen joints are shown as an excuse.
Then I see three well-defined ideas:
- This is a common stupidity, because you can always combine the treatment of two different ailments.
- Let's say (just let's say!) That in nature there is no remedy for simultaneously treating your high blood pressure and your inflamed big toe on your left foot. What would you treat yourself and what would you choose? Would you keep your big toe on your left foot, or keep yourself alive by protecting yourself from high blood pressure? Don't answer right away. Think hard.
- I confirm, indeed, from some drugs that are used to treat blood pressure, the level of uric acid in the blood can rise, and gout will occur.
Diuretic
Indeed, people who receive loop or thiazide diuretics often have high blood uric acid levels. Loop diuretics include drugs like torasemide or furosemide, and thiazide drugs like indapamide or hypothiazide.
Due to the increased level of uric acid in the blood over time, gout may begin, or the gout that has already been exacerbated may worsen.
The point is, diuretics prevent our kidneys from excreting uric acid. Moreover, this effect does not depend on the dose. That is, it is not at all necessary to eat diuretics in large quantities.
Usually, if an increase in uric acid in the blood does not manifest itself in any way, then nothing is done about it. Well, if something hurts, the rheumatologist will quickly cure you.
Who to expect gout
If we take the average men who lower their blood pressure with diuretics, then about 3% of them will wait for their gout.
Rescue with ACE inhibitors
It so happened that if uric acid literally scales in the blood and approaches 900 micromoles per liter in people on diuretics, then very often these people get their diuretics not from a good life, but because they have a heart failure.
It's funny that the blood is poorly filtered in the kidneys, and the kidneys are not threatened with an increased level of uric acid. Well, that is, usually uric acid harms the kidneys after it is filtered from the blood into the urine. And if the heart works poorly, then uric acid is simply not able to be filtered out in dangerous quantities through the kidneys. A pleasant surprise.
And in general, in such a situation, it is not always possible to blame diuretics for increasing uric acid in the blood. Simply because the kidneys are no longer able to remove this uric acid from the blood.
If you already have a diagnosis of gout, and uric acid has already managed to damage you, then even then diuretics are not always canceled. Because there is usually no other way to deal with the swelling.
And on the other hand, if a person does not swell from edema, then diuretics will be easily canceled and a bunch of different drugs will be prescribed to lower blood pressure. Fortunately, now there is a choice.
It's another matter if the cardiologist wants to keep diuretics, and the rheumatologist is trying to treat gout. This can be done, but the rheumatologist will need to stricter control the level of uric acid in the blood and drive its birthmark below 360 micromoles per liter. So that she doesn't even dare to stick her head out of there.
It is clear that not all rheumatologists are ready to use heroic efforts to control the level of uric acid. It is easier to suggest that the patient give up diuretics in the hope, probably, that he will die faster and will not get his complaints about the big toe of his left foot. And I can even understand a rheumatologist to some extent, because he will have to increase the dose of the medicine every two weeks, balancing on the verge of side effects. Not every doctor can stand it.
In fairness, the patients themselves in such a situation can harm themselves by occasionally taking diuretics. Because uric acid precipitates in the form of crystals just during sudden changes in concentration. Therefore, drink diuretics as expected and do not skip. Otherwise, you will only make it worse.
And that's where we finally get to life-saving angiotensin-converting enzyme inhibitors like enalapril and their close relative losartan. They miraculously act on the kidneys and prevent uric acid from being sucked back into the bloodstream. These are great fellows!
The best part is that thiazide diuretics work well with both ACE inhibitors and losartan. This combination also reduces pressure better, and is useful in heart failure. Sheer idyll.
And again, I caught myself only when this article is approaching 5000 characters, which means that half of the readers do not help it. But this topic is interesting to me and I wanted to speak out. Until next time!
