Классические или «новые» тиазидные диуретики при артериальной гипертен

Советы молодым</div></div> <div class="grid-item__meta-secondary"> <div class="grid-product__price"><span class="grid-product__price--current"> <span aria-hidden="true">руб0,00</span> <span class="visually-hidden">руб0,00</span> </span></div> </div></div> </a></div> </div> </div> <div class=" grid-item grid-product grid-product-image-breathing-room--true " > <div class="product-grid-item" data-product-handle="air-pollution-and-heart-disease-how-to-lower-your-risks-9" data-product-id="7374935031964" data-product-grid-item > <div class="grid-item__content"><div class="grid-product__actions"> <is-land on:idle> <quick-shop defer-hydration> <tool-tip-trigger class="tool-tip-trigger" data-tool-tip="QuickShop" data-tool-tip-classes="quick-shop-modal" defer-hydration > <span class="tool-tip-trigger__content" data-tool-tip-trigger-content="" > </span> <button type="button" class="btn btn--circle btn--icon quick-product__btn js-modal-open-quick-modal-7374935031964 small--hide" title=" Quick shop " data-handle="air-pollution-and-heart-disease-how-to-lower-your-risks-9"> <svg xmlns="http://www.w3.org/2000/svg" aria-hidden="true" focusable="false" role="presentation" class="icon icon-search icon--line" viewbox="0 0 64 64" width="20" height="20" > <path d="M47.16 28.58A18.58 18.58 0 1 1 28.58 10a18.58 18.58 0 0 1 18.58 18.58M54 54 41.94 42" stroke-miterlimit="10" fill="none" stroke="currentColor" /> </svg> <span class="icon__fallback-text visually-hidden"> Quick shop </span> </button> </tool-tip-trigger> <script type="module"> import 'components/tool-tip-trigger' </script> </quick-shop> <template data-island> <script type="module"> import 'components/quick-shop' </script> </template> </is-land> </div><a href="/collections/how-to/products/air-pollution-and-heart-disease-how-to-lower-your-risks-9" class="grid-item__link"> <div class="grid-product__image-wrap"> <div class="grid-product__tags"></div><div style="height: 0; padding-bottom: 56.25%;" > <is-land on:visible data-image-type=""><img src="//diagnosticdetectives.ru/cdn/shop/products/Dr_Pier-Mannuccio_Mannucci_thrombosis_bleeding_hematology_treatment_Diagnostic_Detectives_Network.010.jpg?v=1660905407&width=1080" alt="" srcset="//diagnosticdetectives.ru/cdn/shop/products/Dr_Pier-Mannuccio_Mannucci_thrombosis_bleeding_hematology_treatment_Diagnostic_Detectives_Network.010.jpg?v=1660905407&width=360 360w, //diagnosticdetectives.ru/cdn/shop/products/Dr_Pier-Mannuccio_Mannucci_thrombosis_bleeding_hematology_treatment_Diagnostic_Detectives_Network.010.jpg?v=1660905407&width=540 540w, //diagnosticdetectives.ru/cdn/shop/products/Dr_Pier-Mannuccio_Mannucci_thrombosis_bleeding_hematology_treatment_Diagnostic_Detectives_Network.010.jpg?v=1660905407&width=720 720w, //diagnosticdetectives.ru/cdn/shop/products/Dr_Pier-Mannuccio_Mannucci_thrombosis_bleeding_hematology_treatment_Diagnostic_Detectives_Network.010.jpg?v=1660905407&width=900 900w, //diagnosticdetectives.ru/cdn/shop/products/Dr_Pier-Mannuccio_Mannucci_thrombosis_bleeding_hematology_treatment_Diagnostic_Detectives_Network.010.jpg?v=1660905407&width=1080 1080w" width="1080" height="607.5" loading="lazy" class="grid-product__image image-element" sizes="150px" data-animate="fadein"> </is-land> </div></div> <div class="grid-item__meta"> <div class="grid-item__meta-main"><div class="grid-product__title">Загрязнение воздуха и сердечно-сосудистые заболевания. Как снизить риски? Часть 9. [Части 1 и 2]</div></div> <div class="grid-item__meta-secondary"> <div class="grid-product__price"><span class="grid-product__price--current"> <span aria-hidden="true">руб0,00</span> <span class="visually-hidden">руб0,00</span> </span></div> </div></div> </a></div> </div> </div> <div class=" grid-item grid-product grid-product-image-breathing-room--true " > <div class="product-grid-item" data-product-handle="alpha-ketoglutarate-and-longevity-how-to-use-it-with-vitamins-to-slow-aging-9" data-product-id="7466153115804" data-product-grid-item > <div class="grid-item__content"><div class="grid-product__actions"> <is-land on:idle> <quick-shop defer-hydration> <tool-tip-trigger class="tool-tip-trigger" data-tool-tip="QuickShop" data-tool-tip-classes="quick-shop-modal" defer-hydration > <span class="tool-tip-trigger__content" data-tool-tip-trigger-content="" > </span> <button type="button" class="btn btn--circle btn--icon quick-product__btn js-modal-open-quick-modal-7466153115804 small--hide" title=" Quick shop " data-handle="alpha-ketoglutarate-and-longevity-how-to-use-it-with-vitamins-to-slow-aging-9"> <svg xmlns="http://www.w3.org/2000/svg" aria-hidden="true" focusable="false" role="presentation" class="icon icon-search icon--line" viewbox="0 0 64 64" width="20" height="20" > <path d="M47.16 28.58A18.58 18.58 0 1 1 28.58 10a18.58 18.58 0 0 1 18.58 18.58M54 54 41.94 42" stroke-miterlimit="10" fill="none" stroke="currentColor" /> </svg> <span class="icon__fallback-text visually-hidden"> Quick shop </span> </button> </tool-tip-trigger> <script type="module"> import 'components/tool-tip-trigger' </script> </quick-shop> <template data-island> <script type="module"> import 'components/quick-shop' </script> </template> </is-land> </div><a href="/collections/how-to/products/alpha-ketoglutarate-and-longevity-how-to-use-it-with-vitamins-to-slow-aging-9" class="grid-item__link"> <div class="grid-product__image-wrap"> <div class="grid-product__tags"></div><div style="height: 0; 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//diagnosticdetectives.ru/cdn/shop/products/Dr_Brian_K_Kennedy_Antiaging_Longevity_Expert_Second_Opinion_Diagnostic_Detectives_Network.010.jpg?v=1666225541&width=1080 1080w" width="1080" height="607.5" loading="lazy" class="grid-product__image image-element" sizes="150px" data-animate="fadein"> </is-land> </div></div> <div class="grid-item__meta"> <div class="grid-item__meta-main"><div class="grid-product__title"><h1>Альфа-кетоглутарат и долголетие: применение с витаминами для замедления старения</h1> <p>Альфа-кетоглутарат (АКГ)</div></div> <div class="grid-item__meta-secondary"> <div class="grid-product__price"><span class="grid-product__price--current"> <span aria-hidden="true">руб0,00</span> <span class="visually-hidden">руб0,00</span> </span></div> </div></div> </a></div> </div> </div> </div> </div> </div> <div class="cart__footer"> <div class="cart__item-sub cart__item-row cart__item--subtotal"> <div> Subtotal </div> <div data-subtotal>руб0,00</div> </div> <div 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1-24.75-59.75l189.74-189.74L10.25 59.75a35.002 35.002 0 0 1 49.5-49.5l214.49 214.49a35 35 0 0 1 0 49.5L59.75 488.73A34.89 34.89 0 0 1 35 498.98" /> </svg> </a> </li><li class="slide-nav__item"> <a href="/collections/pulmonary-arterial-hypertension" class="slide-nav__link"> <span>Pulmonary Arterial Hypertension</span> <svg xmlns="http://www.w3.org/2000/svg" aria-hidden="true" focusable="false" role="presentation" class="icon icon-chevron-right" viewbox="0 0 284.49 498.98" fill="currentColor" width="20" height="20" > <path d="M35 498.98a35 35 0 0 1-24.75-59.75l189.74-189.74L10.25 59.75a35.002 35.002 0 0 1 49.5-49.5l214.49 214.49a35 35 0 0 1 0 49.5L59.75 488.73A34.89 34.89 0 0 1 35 498.98" /> </svg> </a> </li><li class="slide-nav__item"> <a href="/collections/general-cardiology" class="slide-nav__link"> <span>General Cardiology</span> <svg xmlns="http://www.w3.org/2000/svg" aria-hidden="true" focusable="false" role="presentation" class="icon icon-chevron-right" viewbox="0 0 284.49 498.98" fill="currentColor" width="20" height="20" > <path d="M35 498.98a35 35 0 0 1-24.75-59.75l189.74-189.74L10.25 59.75a35.002 35.002 0 0 1 49.5-49.5l214.49 214.49a35 35 0 0 1 0 49.5L59.75 488.73A34.89 34.89 0 0 1 35 498.98" /> </svg> </a> </li></ul></li><li class="slide-nav__item"><button type="button" class="slide-nav__button js-toggle-submenu" data-target="tier-3-other-organs1" data-active="true" > <span class="slide-nav__link slide-nav__sublist-link"> <span>Other Organs</span> <svg xmlns="http://www.w3.org/2000/svg" aria-hidden="true" focusable="false" role="presentation" class="icon icon-chevron-right" viewbox="0 0 284.49 498.98" fill="currentColor" width="20" height="20" > <path d="M35 498.98a35 35 0 0 1-24.75-59.75l189.74-189.74L10.25 59.75a35.002 35.002 0 0 1 49.5-49.5l214.49 214.49a35 35 0 0 1 0 49.5L59.75 488.73A34.89 34.89 0 0 1 35 498.98" /> </svg> <span class="icon__fallback-text visually-hidden"> Expand submenu </span> </span> </button> <ul class="slide-nav__dropdown" 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> <path d="M35 498.98a35 35 0 0 1-24.75-59.75l189.74-189.74L10.25 59.75a35.002 35.002 0 0 1 49.5-49.5l214.49 214.49a35 35 0 0 1 0 49.5L59.75 488.73A34.89 34.89 0 0 1 35 498.98" /> </svg> </a> </li><li class="slide-nav__item"> <a href="/collections/womens-health" class="slide-nav__link"> <span>Women's Health. Infertility.</span> <svg xmlns="http://www.w3.org/2000/svg" aria-hidden="true" focusable="false" role="presentation" class="icon icon-chevron-right" viewbox="0 0 284.49 498.98" fill="currentColor" width="20" height="20" > <path d="M35 498.98a35 35 0 0 1-24.75-59.75l189.74-189.74L10.25 59.75a35.002 35.002 0 0 1 49.5-49.5l214.49 214.49a35 35 0 0 1 0 49.5L59.75 488.73A34.89 34.89 0 0 1 35 498.98" /> </svg> </a> </li><li class="slide-nav__item"> <a href="/collections/elderly-patients" class="slide-nav__link"> <span>Elderly Patients</span> <svg xmlns="http://www.w3.org/2000/svg" aria-hidden="true" focusable="false" role="presentation" class="icon icon-chevron-right" viewbox="0 0 284.49 498.98" fill="currentColor" width="20" height="20" > <path d="M35 498.98a35 35 0 0 1-24.75-59.75l189.74-189.74L10.25 59.75a35.002 35.002 0 0 1 49.5-49.5l214.49 214.49a35 35 0 0 1 0 49.5L59.75 488.73A34.89 34.89 0 0 1 35 498.98" /> </svg> </a> </li><li class="slide-nav__item"> <a href="/collections/integrative-medicine" class="slide-nav__link"> <span>Integrative Medicine</span> <svg xmlns="http://www.w3.org/2000/svg" aria-hidden="true" focusable="false" role="presentation" class="icon icon-chevron-right" viewbox="0 0 284.49 498.98" fill="currentColor" width="20" height="20" > <path d="M35 498.98a35 35 0 0 1-24.75-59.75l189.74-189.74L10.25 59.75a35.002 35.002 0 0 1 49.5-49.5l214.49 214.49a35 35 0 0 1 0 49.5L59.75 488.73A34.89 34.89 0 0 1 35 498.98" /> </svg> </a> </li><li class="slide-nav__item"> <a href="/collections/nutrition" class="slide-nav__link"> <span>Nutrition</span> <svg xmlns="http://www.w3.org/2000/svg" aria-hidden="true" focusable="false" role="presentation" class="icon icon-chevron-right" viewbox="0 0 284.49 498.98" fill="currentColor" width="20" height="20" > <path d="M35 498.98a35 35 0 0 1-24.75-59.75l189.74-189.74L10.25 59.75a35.002 35.002 0 0 1 49.5-49.5l214.49 214.49a35 35 0 0 1 0 49.5L59.75 488.73A34.89 34.89 0 0 1 35 498.98" /> </svg> </a> </li><li class="slide-nav__item"> <a href="/collections/clinical-cases" class="slide-nav__link"> <span>Clinical Cases</span> <svg xmlns="http://www.w3.org/2000/svg" aria-hidden="true" focusable="false" role="presentation" class="icon icon-chevron-right" viewbox="0 0 284.49 498.98" fill="currentColor" width="20" height="20" > <path d="M35 498.98a35 35 0 0 1-24.75-59.75l189.74-189.74L10.25 59.75a35.002 35.002 0 0 1 49.5-49.5l214.49 214.49a35 35 0 0 1 0 49.5L59.75 488.73A34.89 34.89 0 0 1 35 498.98" /> </svg> </a> </li><li class="slide-nav__item"> <a href="/collections/prognosis" class="slide-nav__link"> <span>Prognosis</span> <svg xmlns="http://www.w3.org/2000/svg" aria-hidden="true" focusable="false" role="presentation" class="icon icon-chevron-right" viewbox="0 0 284.49 498.98" fill="currentColor" width="20" height="20" > <path d="M35 498.98a35 35 0 0 1-24.75-59.75l189.74-189.74L10.25 59.75a35.002 35.002 0 0 1 49.5-49.5l214.49 214.49a35 35 0 0 1 0 49.5L59.75 488.73A34.89 34.89 0 0 1 35 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color: #ffffff !important; border: 2px solid #ffffff !important; font-size: 18px !important; padding: 10px 20px !important; text-align: center !important; display: inline-block !important; text-decoration: none !important; } .custom-white-button:hover { background-color: #ff0000 !important; color: #ffffff !important; } </style> </div> </div> </div> <div class="grid__item one-whole"> <div class="product-summary--wide"> <div class="dd-article-summary rte"> <p>Leading expert in hypertension and nephrology, Dr. David Ellison, MD, explains how to choose between classic and newer thiazide diuretics for high blood pressure treatment. He discusses the ongoing debate between hydrochlorothiazide and chlorthalidone, referencing major clinical trials like HYVET. Dr. Ellison details his clinical approach to managing side effects like hypokalemia and orthostatic hypotension in elderly patients.</p> </div> </div> </div></div> </div> </section> <script type="application/ld+json"> {"@context":"http:\/\/schema.org\/","@id":"\/products\/classic-or-new-thiazide-diuretics-for-hypertension-how-to-choose-7#product","@type":"Product","brand":{"@type":"Brand","name":"DiagnosticDetectives.Com"},"category":"","description":"Choosing the Right Thiazide Diuretic for Hypertension Treatment\n\nJump To Section\n\nThiazide Diuretics Comparison\nClinical Evidence in Hypertension\nGeographic Prescribing Patterns\nManaging Diuretic Side Effects\nElderly Hypertension Treatment\nFuture Research Directions\nFull Transcript\n\n\nThiazide Diuretics Comparison\nDr. David Ellison, MD, explains the key differences between classic and newer thiazide diuretics for hypertension management. He notes that hydrochlorothiazide represents the classic thiazide diuretic, while chlorthalidone and indapamide are considered newer thiazide-like diuretics. Dr. David Ellison, MD, states that direct comparison studies between these medications are limited, creating ongoing debate among hypertension specialists about which drug provides superior blood pressure control with fewer side effects.\n\nClinical Evidence in Hypertension\nDr. David Ellison, MD, discusses the clinical trial evidence supporting different thiazide diuretics. He references the HYVET trial (Hypertension in the Very Elderly Trial) which demonstrated that indapamide effectively reduced stroke risk and other adverse cardiovascular events. Dr. David Ellison, MD, also mentions that chlorthalidone has shown effectiveness in major hypertension studies. Dr. David Ellison, MD, emphasizes that while circumstantial evidence suggests chlorthalidone might be more effective than hydrochlorothiazide, definitive randomized controlled trials comparing these medications directly are still needed.\n\nGeographic Prescribing Patterns\nDr. David Ellison, MD, highlights interesting geographic variations in thiazide diuretic prescribing practices. In the United States, physicians typically choose between hydrochlorothiazide and chlorthalidone, with chlorthalidone often preferred as the long-acting option. Conversely, European countries more commonly prescribe indapamide for hypertension treatment. Dr. David Ellison, MD, notes that these regional preferences have developed without clear evidence establishing superiority of one medication over another, reflecting practice patterns rather than evidence-based differences.\n\nManaging Diuretic Side Effects\nDr. David Ellison, MD, shares his clinical approach to managing thiazide diuretic side effects, particularly hypokalemia (low potassium levels). He recommends implementing a high-potassium diet for patients taking thiazide diuretics to prevent potassium depletion. If dietary measures prove insufficient, Dr. Ellison suggests adding potassium-sparing diuretics like spironolactone or triamterene to the treatment regimen. This proactive management strategy helps maintain electrolyte balance while achieving blood pressure control.\n\nElderly Hypertension Treatment\nDr. David Ellison, MD, addresses specific considerations for treating hypertension in elderly patients with thiazide diuretics. He notes that orthostatic hypotension (blood pressure drop upon standing) represents a particular concern in this population. However, clinical evidence indicates that thiazide diuretics do not cause more syncope (fainting) than other antihypertensive drug classes. Dr. David Ellison, MD, emphasizes that elderly patients clearly benefit from thiazide diuretic therapy when appropriately managed, despite these potential side effect concerns.\n\nFuture Research Directions\nDr. David Ellison, MD, discusses ongoing research that may finally resolve the thiazide diuretic debate. He mentions a Veterans Affairs-sponsored randomized controlled trial currently underway that aims to provide definitive evidence comparing different diuretic classes. Dr. Anton Titov, MD and Dr. Ellison both express interest in these results, which could establish clear guidelines for thiazide diuretic selection in hypertension treatment. This research represents a crucial step toward evidence-based decision making in antihypertensive therapy.\nFull Transcript\nDr. Anton Titov, MD: How to compare classic thiazide diuretics such as hydrochlorothiazide with newer thiazide-like diuretics, for example, chlorthalidone, indapamide, metolazone for the treatment of hypertension? Especially in elderly patients, there have been some pivotal clinical trials in that regard.\n\nDr. David Ellison, MD: I think that we don't really have very good randomized trials, randomized controlled trials, which are considered the gold standard, comparing different classes of diuretics. There's a lot of circumstantial evidence that chlorthalidone is more effective as an antihypertensive drug than hydrochlorothiazide. But I would say that's very circumstantial.\n\nSome studies have suggested that chlorthalidone may actually have excess side effects and have complications to it. So there continues to be this debate about which class of diuretic drug is better.\n\nI must say, in the United States, we typically use chlorthalidone as our long-acting thiazides. In Europe, they use indapamide more. I frankly have never used indapamide. That's a funny, geographically specific behavior pattern, but mostly for us in the United States, it's either hydrochlorothiazide or chlorthalidone.\n\nThere is a randomized controlled trial going on, sponsored by the VA, which is intended to actually answer that question in a definitive way. I'm very anxious to see those results. Many of us have believed that chlorthalidone was a good drug, but then people have again raised this worry about using chlorthalidone. So I think we'd like to settle that once and for all.\n\nYou mentioned hypertension in the elderly. Many big trials were done. CHEP trial tested chlorthalidone. HYVET trial tested indapamide. HYVET is Hypertension Treatment in the Very Elderly. It showed that chlorthalidone and indapamide effectively reduced the risk of strokes and other adverse effects.\n\nThere really is probably not a concern of using chlorthalidone. My own belief, my own practice pattern is that those drugs are great, but I do like to avoid people getting hypokalemia. I use chlorthalidone, but I try to avoid hypokalemia by ensuring they're on a high potassium diet.\n\nAnd then, if need be, adding a potassium-sparing diuretic like spironolactone or triamterene. Conversely, if there's another indication like kidney disease, we would typically start with an ACE inhibitor or angiotensin receptor blocker. But I'm not afraid to use a thiazide-type diuretic, typically chlorthalidone, in my elderly patients.\n\nI think there's clear evidence that the elderly benefit from that class of drugs. So I don't see them as being very different from others.\n\nObviously, the concern in the elderly is often orthostatic hypotension. In the clinic yesterday, we were talking about an elderly patient who had that problem. That's a tough problem. And there, I tend to worry about the vasodilating drugs.\n\nBut again, the data from the use of thiazides is that they don't tend to be more likely to cause syncope than other classes of drugs. And so, I don't avoid them in those patients.\n\nDr. Anton Titov, MD: I did mean exactly the HYVET clinical trial, the hypertension in the very elderly, where I believe indapamide was tested. And indeed, it's used extensively in Europe and in Israel.\n\nDr. David Ellison, MD: Yeah, and I started, I said chlorthalidone, but that was probably indapamide. I look at indapamide and chlorthalidone as pretty interchangeable. But I don't think they've ever been compared directly head-to-head. So that's an interesting thought.\n\nAnd I don't think that any of our formularies carry indapamide in this country. We just don't have that choice. And I tend not to think of that.","image":"https:\/\/diagnosticdetectives.ru\/cdn\/shop\/products\/Dr_David_H_Ellison_Kidney_disease_hypertension_heart_failure_Treatment_Expert_Second_Opinion_Diagnostic_Detectives_Network.007.jpg?v=1680675648\u0026width=1920","name":"Классические или «новые» тиазидные диуретики при артериальной гипертензии: как сделать выбор?","offers":{"@id":"\/products\/classic-or-new-thiazide-diuretics-for-hypertension-how-to-choose-7?variant=42435527377052#offer","@type":"Offer","availability":"http:\/\/schema.org\/InStock","price":"0.00","priceCurrency":"RUB","url":"https:\/\/diagnosticdetectives.ru\/products\/classic-or-new-thiazide-diuretics-for-hypertension-how-to-choose-7?variant=42435527377052"},"url":"https:\/\/diagnosticdetectives.ru\/products\/classic-or-new-thiazide-diuretics-for-hypertension-how-to-choose-7"} </script> </div><section id="shopify-section-template--18622507942044__product_expert_masterclass_teaser_GQjD4Q" class="shopify-section index-section"> <section class="section section--tight" data-section-id="template--18622507942044__product_expert_masterclass_teaser_GQjD4Q"> <div class="page-width"><div class="emc"> <a href="/pages/expert-masterclass/dr-david-h-ellison" class="emc__media" style="--emc-max-w: 960px; --emc-dim: 0.6;"><div class="emc__img emc__img--placeholder js-vimeo-thumb" aria-hidden="true"></div><span class="emc__overlay" aria-hidden="true"></span> <span class="emc__cta emc__cta--center"> <span class="emc__cta-btn"> <span class="emc__icon" aria-hidden="true"> <svg viewBox="0 0 48 48" class="emc__icon-svg" role="presentation" focusable="false" aria-hidden="true"> <circle cx="24" cy="24" r="22" fill="none" stroke="currentColor" stroke-width="2"></circle>  <polygon points="20,16 34,24 20,32" fill="#e11d48"></polygon> </svg> </span> <span class="emc__cta-text">Watch full Masterclass with Dr. David H. 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padding-bottom: 56.25%;" > <is-land on:visible data-image-type=""><img src="//diagnosticdetectives.ru/cdn/shop/products/Dr_Tracey_Milligan_Medical_Second_Opinion_Diagnostic_Detectives_Network_Epilepsy-treatment-seizures-refractory-diet-cannabidiol.003.jpg?v=1660933378&width=1080" alt="" srcset="//diagnosticdetectives.ru/cdn/shop/products/Dr_Tracey_Milligan_Medical_Second_Opinion_Diagnostic_Detectives_Network_Epilepsy-treatment-seizures-refractory-diet-cannabidiol.003.jpg?v=1660933378&width=360 360w, //diagnosticdetectives.ru/cdn/shop/products/Dr_Tracey_Milligan_Medical_Second_Opinion_Diagnostic_Detectives_Network_Epilepsy-treatment-seizures-refractory-diet-cannabidiol.003.jpg?v=1660933378&width=540 540w, //diagnosticdetectives.ru/cdn/shop/products/Dr_Tracey_Milligan_Medical_Second_Opinion_Diagnostic_Detectives_Network_Epilepsy-treatment-seizures-refractory-diet-cannabidiol.003.jpg?v=1660933378&width=720 720w, //diagnosticdetectives.ru/cdn/shop/products/Dr_Tracey_Milligan_Medical_Second_Opinion_Diagnostic_Detectives_Network_Epilepsy-treatment-seizures-refractory-diet-cannabidiol.003.jpg?v=1660933378&width=900 900w, //diagnosticdetectives.ru/cdn/shop/products/Dr_Tracey_Milligan_Medical_Second_Opinion_Diagnostic_Detectives_Network_Epilepsy-treatment-seizures-refractory-diet-cannabidiol.003.jpg?v=1660933378&width=1080 1080w" width="1080" height="607.5" loading="lazy" class="grid-product__image image-element" sizes="30vw" data-animate="fadein"> </is-land> </div></div> <div class="grid-item__meta"> <div class="grid-item__meta-main"><div class="grid-product__title">55% пациентов с эпилепсией никогда не обращаются к специалисту. Как правильно диагностировать эпилептические приступы?</div></div> <div class="grid-item__meta-secondary"> <div class="grid-product__price"><span class="grid-product__price--current"> <span aria-hidden="true">руб0,00</span> <span class="visually-hidden">руб0,00</span> </span></div> </div></div> </a></div> </div> </div> <div class=" grid-item grid-product grid-product-image-breathing-room--true " > <div class="product-grid-item" data-product-handle="advice-to-young-neurosurgeons-how-to-become-a-skilled-surgeon-8" data-product-id="7374949220508" data-product-grid-item > <div class="grid-item__content"><div class="grid-product__actions"> <is-land on:idle> <quick-shop defer-hydration> <tool-tip-trigger class="tool-tip-trigger" data-tool-tip="QuickShop" data-tool-tip-classes="quick-shop-modal" defer-hydration > <span class="tool-tip-trigger__content" data-tool-tip-trigger-content="" > </span> <button type="button" class="btn btn--circle btn--icon quick-product__btn js-modal-open-quick-modal-7374949220508 small--hide" title=" Quick shop " data-handle="advice-to-young-neurosurgeons-how-to-become-a-skilled-surgeon-8"> <svg xmlns="http://www.w3.org/2000/svg" aria-hidden="true" focusable="false" role="presentation" class="icon icon-search icon--line" viewbox="0 0 64 64" width="20" height="20" > <path d="M47.16 28.58A18.58 18.58 0 1 1 28.58 10a18.58 18.58 0 0 1 18.58 18.58M54 54 41.94 42" stroke-miterlimit="10" fill="none" stroke="currentColor" /> </svg> <span class="icon__fallback-text visually-hidden"> Quick shop </span> </button> </tool-tip-trigger> <script type="module"> import 'components/tool-tip-trigger' </script> </quick-shop> <template data-island> <script type="module"> import 'components/quick-shop' </script> </template> </is-land> </div><a href="/collections/how-to/products/advice-to-young-neurosurgeons-how-to-become-a-skilled-surgeon-8" class="grid-item__link"> <div class="grid-product__image-wrap"> <div class="grid-product__tags"></div><div style="height: 0; 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Как снизить риски? Часть 9. 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padding-bottom: 41.666666666666664%;" > <is-land on:visible data-image-type="photoswipe"> <img src="//diagnosticdetectives.ru/cdn/shop/products/Experts_Diagnostic_Detectives_Network_MD_PhDcopy.002.jpg?v=1666367638&width=1080" alt="Уточните план лечения, проконсультировавшись с ведущими специалистами, которые полностью соответствуют вашему клиническому случаю." srcset="//diagnosticdetectives.ru/cdn/shop/products/Experts_Diagnostic_Detectives_Network_MD_PhDcopy.002.jpg?v=1666367638&width=360 360w, //diagnosticdetectives.ru/cdn/shop/products/Experts_Diagnostic_Detectives_Network_MD_PhDcopy.002.jpg?v=1666367638&width=540 540w, //diagnosticdetectives.ru/cdn/shop/products/Experts_Diagnostic_Detectives_Network_MD_PhDcopy.002.jpg?v=1666367638&width=720 720w, //diagnosticdetectives.ru/cdn/shop/products/Experts_Diagnostic_Detectives_Network_MD_PhDcopy.002.jpg?v=1666367638&width=900 900w, //diagnosticdetectives.ru/cdn/shop/products/Experts_Diagnostic_Detectives_Network_MD_PhDcopy.002.jpg?v=1666367638&width=1080 1080w" width="1080" height="450.0" loading="eager" class=" image-element" data-photoswipe-src="//diagnosticdetectives.ru/cdn/shop/products/Experts_Diagnostic_Detectives_Network_MD_PhDcopy.002.jpg?v=1666367638&width=1800" data-photoswipe-width="1920" data-photoswipe-height="800" data-index="1" sizes=" (min-width: 769px) 50vw, 75vw" data-animate="none"> </is-land> </div><div class="product__video-wrapper"> <is-land on:idle> <div class="video-media aspect-ratio--16-9" data-background="false" ><video-media defer-hydration > <video playsinline="true" controls="controls" preload="metadata" aria-label="Уточните план лечения, проконсультировавшись с ведущими специалистами, которые полностью соответствуют вашему клиническому случаю." poster="//diagnosticdetectives.ru/cdn/shop/products/Experts_Diagnostic_Detectives_Network_MD_PhDcopy.002_500x.jpg?v=1666367638"><source src="//diagnosticdetectives.ru/cdn/shop/videos/c/vp/a22b0d50e4c64d9c8b0a558888197f4a/a22b0d50e4c64d9c8b0a558888197f4a.HD-720p-4.5Mbps-8813343.mp4?v=0" type="video/mp4"><img src="//diagnosticdetectives.ru/cdn/shop/products/Experts_Diagnostic_Detectives_Network_MD_PhDcopy.002_500x.jpg?v=1666367638"></video> </video-media></div> <template data-island> <script type="module"> import 'components/video-media' </script> </template> </is-land> </div></div> </div> </div></div> <div data-product-thumbs class="product__thumbs product__thumbs--beside product__thumbs-placement--left medium-up--hide small--hide" data-position="beside" data-arrows="false" ><div class="product__thumbs--scroller"></div></div> </div> <script type="application/json" data-current-variant-json>{"id":41852130001052,"title":"Default Title","option1":"Default Title","option2":null,"option3":null,"sku":"","requires_shipping":false,"taxable":false,"featured_image":null,"available":true,"name":"Уточните план лечения, проконсультировавшись с ведущими специалистами, которые полностью соответствуют вашему клиническому случаю.","public_title":null,"options":["Default Title"],"price":0,"weight":0,"compare_at_price":null,"inventory_management":null,"barcode":"","requires_selling_plan":false,"selling_plan_allocations":[]}</script> <script type="application/json" data-product-options-json>["Title"]</script> </product-images> <script type="module"> import 'components/product-images' </script> <script type="application/json" id="ModelJson-template--18622507942044__featured_product_LHGeFD"> [] </script><div class="localized-video-iframe-container" style="margin-top: 1.5rem;"> <div id="language-selector-wrapper"> <label for="language-selector">🎧 Select dubbed video language:</label> <select id="language-selector"> <option value="">Choose dubbed language</option> <option value="de" >Deutsch</option> <option value="fr" >Français</option> <option value="ru" selected>Русский</option> <option value="it" >Italiano</option> <option value="es" >Español</option> <option value="pt" >Português</option> <option value="ar" >العربية</option> <option value="zh" >中文</option> <option value="ja" >日本語</option> <option value="ko" >한국어</option> </select> </div> <iframe id="localized-video-iframe" src="https://player.vimeo.com/video/1113043591?autoplay=0&title=0&byline=0&portrait=0" data-selected-lang="ru" frameborder="0" allow="autoplay; fullscreen" allowfullscreen loading="lazy" style="width:100%; aspect-ratio:16/9; margin-top: 0.5rem;"> </iframe> </div></div><div class="product-grid__content product--description product-single__sticky grid__item medium-up--one-half"> <div class="product-single__meta"> <div class="product-block" data-section-id="template--18622507942044__featured_product_LHGeFD" > <h1 class="h2 product-single__title">Уточните план лечения, проконсультировавшись с ведущими специалистами, которые полностью соответствуют вашему клиническому случаю.</h1></div> <div class="product-block" > <a class="custom-white-button" href="/pages/how-it-works" target="_self" rel="noopener noreferrer"> Can we help? </a> <style> .custom-white-button { background-color: transparent !important; color: #ffffff !important; border: 2px solid #ffffff !important; font-size: 18px !important; padding: 10px 20px !important; text-align: center !important; display: inline-block !important; text-decoration: none !important; } .custom-white-button:hover { background-color: #ff0000 !important; color: #ffffff !important; } </style> </div> </div> </div></div> </div> </section> <script> document.addEventListener("DOMContentLoaded", function () { const selector = document.getElementById("language-selector"); const iframe = document.getElementById("localized-video-iframe"); if (!selector || !iframe) return; // 🧠 Detect the language used in video (via data attribute from Liquid) const loadedLang = iframe.getAttribute("data-selected-lang"); if (loadedLang) { selector.value = loadedLang; } // 🧠 On dropdown change, switch video selector.addEventListener("change", function () { const lang = selector.value; if (!lang) return; const metafieldUrl = {"vimeo_url_ar":"https:\/\/player.vimeo.com\/video\/1113042680","vimeo_url_de":"https:\/\/player.vimeo.com\/video\/1113042888","vimeo_url_es":"https:\/\/player.vimeo.com\/video\/1113043009","vimeo_url_fr":"https:\/\/player.vimeo.com\/video\/1113043115","vimeo_url_it":"https:\/\/player.vimeo.com\/video\/1113043209","vimeo_url_ja":"https:\/\/player.vimeo.com\/video\/1113043318","vimeo_url_ko":"https:\/\/player.vimeo.com\/video\/1113043403","vimeo_url_pt":"https:\/\/player.vimeo.com\/video\/1113043502","vimeo_url_ru":"https:\/\/player.vimeo.com\/video\/1113043591","vimeo_url_zh":"https:\/\/player.vimeo.com\/video\/1113042779"}; 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const iframe = document.getElementById("localized-video-iframe"); if (!selector || !iframe) return; // 🧠 Detect the language used in video (via data attribute from Liquid) const loadedLang = iframe.getAttribute("data-selected-lang"); if (loadedLang) { selector.value = loadedLang; } // 🧠 On dropdown change, switch video selector.addEventListener("change", function () { const lang = selector.value; if (!lang) return; const metafieldUrl = {}; const urlKey = "vimeo_url_" + lang; const newUrl = metafieldUrl[urlKey]; if (newUrl) { iframe.src = newUrl + "?autoplay=0&title=0&byline=0&portrait=0"; } }); }); </script> </div><div id="shopify-section-template--18622507942044__sub" class="shopify-section product-full-width"> <div class="page-width page-width--narrow"> <div class="product-block" > <at-rte class="at-rte rte clearfix"> <h1>Choosing the Right Thiazide Diuretic for Hypertension Treatment</h1> <h3>Jump To Section</h3> <ul> <li><a href="#thiazide-diuretics-comparison">Thiazide Diuretics Comparison</a></li> <li><a href="#clinical-evidence-hypertension">Clinical Evidence in Hypertension</a></li> <li><a href="#geographic-prescribing-patterns">Geographic Prescribing Patterns</a></li> <li><a href="#managing-diuretic-side-effects">Managing Diuretic Side Effects</a></li> <li><a href="#elderly-hypertension-treatment">Elderly Hypertension Treatment</a></li> <li><a href="#future-research-directions">Future Research Directions</a></li> <li><a href="#full-transcript">Full Transcript</a></li> </ul> <h2 id="thiazide-diuretics-comparison">Thiazide Diuretics Comparison</h2> <p>Dr. David Ellison, MD, explains the key differences between classic and newer thiazide diuretics for hypertension management. He notes that hydrochlorothiazide represents the classic thiazide diuretic, while chlorthalidone and indapamide are considered newer thiazide-like diuretics. Dr. David Ellison, MD, states that direct comparison studies between these medications are limited, creating ongoing debate among hypertension specialists about which drug provides superior blood pressure control with fewer side effects.</p> <h2 id="clinical-evidence-hypertension">Clinical Evidence in Hypertension</h2> <p>Dr. David Ellison, MD, discusses the clinical trial evidence supporting different thiazide diuretics. He references the HYVET trial (Hypertension in the Very Elderly Trial) which demonstrated that indapamide effectively reduced stroke risk and other adverse cardiovascular events. Dr. David Ellison, MD, also mentions that chlorthalidone has shown effectiveness in major hypertension studies. Dr. David Ellison, MD, emphasizes that while circumstantial evidence suggests chlorthalidone might be more effective than hydrochlorothiazide, definitive randomized controlled trials comparing these medications directly are still needed.</p> <h2 id="geographic-prescribing-patterns">Geographic Prescribing Patterns</h2> <p>Dr. David Ellison, MD, highlights interesting geographic variations in thiazide diuretic prescribing practices. In the United States, physicians typically choose between hydrochlorothiazide and chlorthalidone, with chlorthalidone often preferred as the long-acting option. Conversely, European countries more commonly prescribe indapamide for hypertension treatment. Dr. David Ellison, MD, notes that these regional preferences have developed without clear evidence establishing superiority of one medication over another, reflecting practice patterns rather than evidence-based differences.</p> <h2 id="managing-diuretic-side-effects">Managing Diuretic Side Effects</h2> <p>Dr. David Ellison, MD, shares his clinical approach to managing thiazide diuretic side effects, particularly hypokalemia (low potassium levels). He recommends implementing a high-potassium diet for patients taking thiazide diuretics to prevent potassium depletion. If dietary measures prove insufficient, Dr. Ellison suggests adding potassium-sparing diuretics like spironolactone or triamterene to the treatment regimen. This proactive management strategy helps maintain electrolyte balance while achieving blood pressure control.</p> <h2 id="elderly-hypertension-treatment">Elderly Hypertension Treatment</h2> <p>Dr. David Ellison, MD, addresses specific considerations for treating hypertension in elderly patients with thiazide diuretics. He notes that orthostatic hypotension (blood pressure drop upon standing) represents a particular concern in this population. However, clinical evidence indicates that thiazide diuretics do not cause more syncope (fainting) than other antihypertensive drug classes. Dr. David Ellison, MD, emphasizes that elderly patients clearly benefit from thiazide diuretic therapy when appropriately managed, despite these potential side effect concerns.</p> <h2 id="future-research-directions">Future Research Directions</h2> <p>Dr. David Ellison, MD, discusses ongoing research that may finally resolve the thiazide diuretic debate. He mentions a Veterans Affairs-sponsored randomized controlled trial currently underway that aims to provide definitive evidence comparing different diuretic classes. Dr. Anton Titov, MD and Dr. Ellison both express interest in these results, which could establish clear guidelines for thiazide diuretic selection in hypertension treatment. This research represents a crucial step toward evidence-based decision making in antihypertensive therapy.</p> <h2 id="full-transcript">Full Transcript</h2> <p><strong>Dr. Anton Titov, MD:</strong> How to compare classic thiazide diuretics such as hydrochlorothiazide with newer thiazide-like diuretics, for example, chlorthalidone, indapamide, metolazone for the treatment of hypertension? Especially in elderly patients, there have been some pivotal clinical trials in that regard.</p> <p><strong>Dr. David Ellison, MD:</strong> I think that we don't really have very good randomized trials, randomized controlled trials, which are considered the gold standard, comparing different classes of diuretics. There's a lot of circumstantial evidence that chlorthalidone is more effective as an antihypertensive drug than hydrochlorothiazide. But I would say that's very circumstantial.</p> <p>Some studies have suggested that chlorthalidone may actually have excess side effects and have complications to it. So there continues to be this debate about which class of diuretic drug is better.</p> <p>I must say, in the United States, we typically use chlorthalidone as our long-acting thiazides. In Europe, they use indapamide more. I frankly have never used indapamide. That's a funny, geographically specific behavior pattern, but mostly for us in the United States, it's either hydrochlorothiazide or chlorthalidone.</p> <p>There is a randomized controlled trial going on, sponsored by the VA, which is intended to actually answer that question in a definitive way. I'm very anxious to see those results. Many of us have believed that chlorthalidone was a good drug, but then people have again raised this worry about using chlorthalidone. So I think we'd like to settle that once and for all.</p> <p>You mentioned hypertension in the elderly. Many big trials were done. CHEP trial tested chlorthalidone. HYVET trial tested indapamide. HYVET is Hypertension Treatment in the Very Elderly. It showed that chlorthalidone and indapamide effectively reduced the risk of strokes and other adverse effects.</p> <p>There really is probably not a concern of using chlorthalidone. My own belief, my own practice pattern is that those drugs are great, but I do like to avoid people getting hypokalemia. I use chlorthalidone, but I try to avoid hypokalemia by ensuring they're on a high potassium diet.</p> <p>And then, if need be, adding a potassium-sparing diuretic like spironolactone or triamterene. Conversely, if there's another indication like kidney disease, we would typically start with an ACE inhibitor or angiotensin receptor blocker. But I'm not afraid to use a thiazide-type diuretic, typically chlorthalidone, in my elderly patients.</p> <p>I think there's clear evidence that the elderly benefit from that class of drugs. So I don't see them as being very different from others.</p> <p>Obviously, the concern in the elderly is often orthostatic hypotension. In the clinic yesterday, we were talking about an elderly patient who had that problem. That's a tough problem. And there, I tend to worry about the vasodilating drugs.</p> <p>But again, the data from the use of thiazides is that they don't tend to be more likely to cause syncope than other classes of drugs. And so, I don't avoid them in those patients.</p> <p><strong>Dr. Anton Titov, MD:</strong> I did mean exactly the HYVET clinical trial, the hypertension in the very elderly, where I believe indapamide was tested. And indeed, it's used extensively in Europe and in Israel.</p> <p><strong>Dr. David Ellison, MD:</strong> Yeah, and I started, I said chlorthalidone, but that was probably indapamide. I look at indapamide and chlorthalidone as pretty interchangeable. But I don't think they've ever been compared directly head-to-head. So that's an interesting thought.</p> <p>And I don't think that any of our formularies carry indapamide in this country. We just don't have that choice. 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