HCTZ and Insulin Resistance

[aHarness]

Hello, curious if anyone has seen issues with insulin resistance from adding in HCTZ for blood pressure?

I was reading it can cause problems, but I was planning to add a low dose like 25mg to control blood pressure this next offseason.

 

[beastmode121]

it has nothin to do with it. Add it

 

[aHarness]

it has nothin to do with it. Add it

Will do! What dosage have you found works for yourself?

 

[CorgisOnTren]

Hello, curious if anyone has seen issues with insulin resistance from adding in HCTZ for blood pressure?

I was reading it can cause problems, but I was planning to add a low dose like 25mg to control blood pressure this next offseason.

I believe this is only if the HCTZ causes a patients potassium to be too low, causing issues with the body producing insulin. Most of us here likely don’t need to worry about that if I had to guess.

Thiazide-Induced Hyperglycemia

In recent years, there has been the suggestion that thiazide diuretics--long considered a front-line therapy for hypertension based on the ALLHAT study and othe

www.renalfellow.org

I think this discusses how when hypokalemia was corrected, so was serum glucose.

 

[trenned]

Thiazides can cause ed

 

[Lumpi]

it has nothin to do with it.

I don't think this is correct. As for monotherapy there is a lot of medical evidence and studies on that. HCTZ does not only impair glucose clearance that leads to insulin resistance but also raises Ldl, triglycerides, hematocrit, and a couple other things. If he is on gear the last thing to take is a diuretic - there is so many better options, better for both his blood pressure management but also his metabolic panel.

The metabolic cost of lowering blood pressure with hydrochlorothiazide - Diabetology & Metabolic Syndrome

Background The landmark Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT) placed a new spotlight on thiazide diuretics as the first-line therapy for hypertension. This is concerning as thiazide-diuretics may contribute to comorbidities associated with the...

dmsjournal.biomedcentral.com

HCTZ treatment worsened hepatic steatosis measured as hepatic triglyceride content and reduced insulin sensitivity.

Interesting comparison of HCTZ monotherapy vs captopril monotherapy:

Captopril increased the insulin-mediated disposal of glucose, as compared with placebo, from 5.7±2.4 to 6.3±2.5 mg per kilogram of body weight per minute (P<0.05), whereas hydrochlorothiazide caused a decrease from 6.4±2.0 to 5.7±1.9 (P<0.01). Captopril had no effect on the basal insulin concentration, but it decreased the late (30- to 90-minute) insulin response to glucose and increased the early (2- to 6-minute) insulin peak. Hydrochlorothiazide increased the basal insulin concentration and the late insulin response to glucose. These findings may be explained by an increase in insulin sensitivity with captopril and a decrease with hydrochlorothiazide. Little or no change was seen in serum lipid or lipoprotein levels during treatment with captopril, whereas hydrochlorothiazide caused significant increases in serum total (5 percent) and low-density lipoprotein (6 percent) cholesterol levels and total (15 percent) and very-low-density lipoprotein (25 percent) triglyceride levels, as compared with placebo (P<0.01 for all comparisons).

https://www.nejm.org/doi/full/10.1056/NEJM198909283211305

A significant rise in the total serum cholesterol level (4.64±0.23 vs. 4.25±0.18 mmol/l before treatment,P<0.01) and the lowdensity lipoprotein (LDL)-cholesterol fraction (2.6±0.24 vs. 2.31±0.31 before treatment,P<0.01) was observed at the end of the 3rd month, while high-density lipoprotein (HDL)-cholesterol was slightly decreased. A significant elevation of the LDL/HDL ratio was also observed (from 1.76±0.17 to 2.2±0.17,P<0.001), indicating an increase in the atherogenic cholesterol fractions.

Hydrochlorothiazide treatment of children with hypercalciuria: effects and side effects - Pediatric Nephrology

Urinary excretion of calcium and the changes in serum cholesterol fractions were investigated in 15 children with renal hypercalciuria, following 3-month hydrochlorothiazide (HCT) treatment (daily dose 1 mg/kg). Urinary calcium excretion (expressed as the ratio of calcium to creatinine) reached...

link.springer.com

 

[beastmode121]

I don't think this is correct. As for monotherapy there is a lot of medical evidence and studies on that. HCTZ does not only impair glucose clearance that leads to insulin resistance but also raises Ldl, triglycerides, hematocrit, and a couple other things. If he is on gear the last thing to take is a diuretic - there is so many better options, better for both his blood pressure management but also his metabolic panel.

The metabolic cost of lowering blood pressure with hydrochlorothiazide - Diabetology & Metabolic Syndrome

Background The landmark Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT) placed a new spotlight on thiazide diuretics as the first-line therapy for hypertension. This is concerning as thiazide-diuretics may contribute to comorbidities associated with the...

dmsjournal.biomedcentral.com

Interesting comparison of HCTZ monotherapy vs captopril monotherapy:

https://www.nejm.org/doi/full/10.1056/NEJM198909283211305

Hydrochlorothiazide treatment of children with hypercalciuria: effects and side effects - Pediatric Nephrology

Urinary excretion of calcium and the changes in serum cholesterol fractions were investigated in 15 children with renal hypercalciuria, following 3-month hydrochlorothiazide (HCT) treatment (daily dose 1 mg/kg). Urinary calcium excretion (expressed as the ratio of calcium to creatinine) reached...

link.springer.com

a bro using google to recommend medication to another bro.

I don't think this is correct. As for monotherapy there is a lot of medical evidence and studies on that. HCTZ does not only impair glucose clearance that leads to insulin resistance but also raises Ldl, triglycerides, hematocrit, and a couple other things. If he is on gear the last thing to take is a diuretic - there is so many better options, better for both his blood pressure management but also his metabolic panel.

The metabolic cost of lowering blood pressure with hydrochlorothiazide - Diabetology & Metabolic Syndrome

Background The landmark Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT) placed a new spotlight on thiazide diuretics as the first-line therapy for hypertension. This is concerning as thiazide-diuretics may contribute to comorbidities associated with the...

dmsjournal.biomedcentral.com

Interesting comparison of HCTZ monotherapy vs captopril monotherapy:

https://www.nejm.org/doi/full/10.1056/NEJM198909283211305

Hydrochlorothiazide treatment of children with hypercalciuria: effects and side effects - Pediatric Nephrology

Urinary excretion of calcium and the changes in serum cholesterol fractions were investigated in 15 children with renal hypercalciuria, following 3-month hydrochlorothiazide (HCT) treatment (daily dose 1 mg/kg). Urinary calcium excretion (expressed as the ratio of calcium to creatinine) reached...

link.springer.com

This is the dumbest thing ever

These studies are not controlled what so ever.

I would take them with a grain of salt.

 

[Mufasa123]

Used hctz for a decade as water retention is what drives my BP. Have seen zero effect on ldl/tris whereas diet has had a pronounced effect on both. Hasn't moved my fasting glucose one iota (hgh has a mild effect, tren lowers it into the low 70s, as does Glucophage in the absence of tren - I never combine them or I go hypo too often). I watch rbc and crit closely as I routinely sit at 48 or higher crit with my lowest reading in 20+ years being 46 (and it's still the same base even after getting on a CPAP for apnea though I don't drift up nearly as much even running higher doses of aas). Hctz being a diuretic I'd assume can move crit but at the water level as opposed to impact in rbcs. I haven't seen any issues but logical. Hydration is important and they'll tell anyone this on a crit test.

 

[aHarness]

Used hctz for a decade as water retention is what drives my BP. Have seen zero effect on ldl/tris whereas diet has had a pronounced effect on both. Hasn't moved my fasting glucose one iota (hgh has a mild effect, tren lowers it into the low 70s, as does Glucophage in the absence of tren - I never combine them or I go hypo too often). I watch rbc and crit closely as I routinely sit at 48 or higher crit with my lowest reading in 20+ years being 46 (and it's still the same base even after getting on a CPAP for apnea though I don't drift up nearly as much even running higher doses of aas). Hctz being a diuretic I'd assume can move crit but at the water level as opposed to impact in rbcs. I haven't seen any issues but logical. Hydration is important and they'll tell anyone this on a crit test.

What dose do you use?

 

[Mufasa123]

What dose do you use?

12.5mg. If I'm reintroducing hgh, due to water retention, I'll add another 12.5mg until things settle otherwise I have to go very slow. That said the 12.5mg from my Dr I've probably been on 12+ years. It's actually not enough - I need a decent diet (low carb) as well but that's win/win for me.

 

[aHarness]

12.5mg. If I'm reintroducing hgh, due to water retention, I'll add another 12.5mg until things settle otherwise I have to go very slow. That said the 12.5mg from my Dr I've probably been on 12+ years. It's actually not enough - I need a decent diet (low carb) as well but that's win/win for me.

Thank you! After speaking with @luki7788 as well I am also considering Indapamide at a low dose of 1.5mg, in research it seems to be a bit stronger.

My only concern with adding a diuretic at this point is potentially effecting my performance in the gym from dehydration/flatness/decreased pumps.

 

[A50#]

Thiazides can cause ed

Yes indeed, I quite using HCTZ awhile back because of this.

 

[Mufasa123]

Thank you! After speaking with @luki7788 as well I am also considering Indapamide at a low dose of 1.5mg, in research it seems to be a bit stronger.

My only concern with adding a diuretic at this point is potentially effecting my performance in the gym from dehydration/flatness/decreased pumps.

For what it's worth I never noticed any of that on the gym. Maybe some people feel it initially but things stabalize in a couple weeks. BP is weird and different meds help different people with combos being even more effective. I take a relatively low dose but have never seen any of these issues. For my specific issue it works well without sides but can't guarantee you/I are same or even similar. Good luck though, most are able to find benign and easy solutions without sides.

 

[bg65]

Chlorthalidone is a better med than HCTZ if you're looking for that approach to manage HTN. It has a much longer half-life and is better at lowering BP

 

[bg65]

a bro using google to recommend medication to another bro.

This is the dumbest thing ever

These studies are not controlled what so ever.

I would take them with a grain of salt.

Well, at least he posted studies. Not just his opinion, right? You recommended a med to a "bro" w/o citing anything (not sure if you're using "bro" as a subtle insult) There's plenty of studies that hctz can increase blood glucose but the effect is minimal, like single digit increases in fasting blood sugar. Its real enough that its in the information packet that comes w the drug. Someone that is otherwise healthy probably doesn't need to worry abt it though. Someone w pre- or full blown diabetes, maybe they should avoid it

 

[bg65]

Chlorthalidone is a better med than HCTZ if you're looking for that approach to manage HTN. It has a much longer half-life and is better at lowering BP

This is copied from a study in the journal Hypertension

Hydrochlorothiazide Versus Chlorthalidone
Evidence Supporting Their Interchangeability

"Should one diuretic be preferred on the basis of the scientific evidence? Both HCTZ and chlorthalidone have demonstrated risk reduction in clinical trials. However, the largest trials, including Hypertension Detection and Follow-up Program (HDFP), MRFIT, Systolic Hypertension in the Elderly Program (SHEP), and ALLHAT, primarily used chlorthalidone as the initial therapy and more consistently showed reductions in cardiovascular events than did studies that primarily used HCTZ"

But the same article went on to propose that they are largely interchangeable, just use one of them was kind of the basic take home.
I remember an article that came out probably about 15 yrs ago or so that showed chlorthalidone provided better ambulatory BP control than HCTZ but i can't find it.
HCTZ used to be a required med to be able to diagnose someone w resistant HTN. Like to qualify for resistant HTN they had to be on X-number of BP meds (i forget how many but i think 3) and one of them had to be hctz.
Last i read abt it the hctz was no longer a required component.
Now I'm just rambling.... just control your blood pressure through whichever meds work for you and you can consistently get

 

[aHarness]

Well, at least he posted studies. Not just his opinion, right? You recommended a med to a "bro" w/o citing anything (not sure if you're using "bro" as a subtle insult) There's plenty of studies that hctz can increase blood glucose but the effect is minimal, like single digit increases in fasting blood sugar. Its real enough that its in the information packet that comes w the drug. Someone that is otherwise healthy probably doesn't need to worry abt it though. Someone w pre- or full blown diabetes, maybe they should avoid it

I would imagine those slight increases too in BG are simply from mild dehydration too if anything, which I’m sure many of us here are on top of. Correct me if I’m wrong though.

 

[Lumpi]

I would imagine those slight increases too in BG are simply from mild dehydration too if anything, which I’m sure many of us here are on top of. Correct me if I’m wrong though.

If you are implying that you can counteract the diuretic effect by just simply drinking more water then I have my doubts.

 

[aHarness]

If you are implying that you can counteract the diuretic effect by just simply drinking more water then I have my doubts.

I’m not. Water yes but electrolytes more importantly, which are essential for transporting glucose. Lack of electrolytes (from a diuretic) would surely cause more circulating blood sugar in the bloodstream, so it’s definitely a possibility and surely wouldn’t hurt.

 

[beastmode121]

Well, at least he posted studies. Not just his opinion, right? You recommended a med to a "bro" w/o citing anything (not sure if you're using "bro" as a subtle insult) There's plenty of studies that hctz can increase blood glucose but the effect is minimal, like single digit increases in fasting blood sugar. Its real enough that its in the information packet that comes w the drug. Someone that is otherwise healthy probably doesn't need to worry abt it though. Someone w pre- or full blown diabetes, maybe they should avoid it

I work in medicine so I can recommend a medication that I personally give and see it’s affect on 100s of people with blood work involved. I know what I’m talking about, that’s why “research” is useless in this situation. When they post a study about bodybuilders taking AAS then we can debate a topic, but I don’t see it, do you?

Were the subjects obese? Did they have other meds on board while taking HCTZ?