• Diuretics are for symptomatic relief and should never be used alone
  • The goal of therapy is euvolemia with the minimum effective dose
  • Regular fluid assessment is key
  • Encourage daily weights to monitor shifts in fluid balance
  • If titration of dose is limited by hypotension:
    • - Reassess diuretic use
    • - Consider staggering dosing with other antihypertensives or dosing at bedtime
  • Other adverse effects:
    • - Electrolyte disturbances: K+ (except K+ sparing), Mg+, Na+, Ca++ (except thiazides)
    • - Diuretics can increase uric acid levels and predispose patients to gout and gout attacks
    • - Be mindful of combination antihypertensive products that may include diuretic agents
  • If non-responsive, consider:
    • - Adherence
    • - Increase sodium intake
    • - NSAID/COX-2 inhibitor use
    • - renal dysfunction (may require higher doses)