From the Guidelines
Hypertension itself does not directly cause frequent urination, but medications used to treat it, such as diuretics, can increase urination as a side effect. The primary mechanism of action of diuretics, like hydrochlorothiazide, furosemide, or spironolactone, is to help the kidneys remove excess sodium and water from the body, reducing blood volume and lowering blood pressure 1. As a result, patients may experience more frequent urination, especially in the first few weeks of starting these medications.
Key Points to Consider
- Diuretics are commonly used in the treatment of hypertension and can cause frequent urination as a side effect 1.
- The 2017 American College of Cardiology/American Heart Association hypertension guideline recommends the use of diuretics, such as chlorthalidone or indapamide, in the treatment of resistant hypertension 1.
- If patients are experiencing bothersome frequent urination while taking blood pressure medication, they should consult their healthcare provider, who may adjust the dosage, change the timing of the medication, or switch to a different type of blood pressure medication that doesn't have this side effect.
- Frequent urination can also be caused by other conditions, such as diabetes, urinary tract infections, or prostate issues, so if this symptom persists, it warrants medical evaluation.
Management and Treatment
The treatment of hypertension includes lifestyle modifications and pharmacological interventions. Diuretics are often used as a first-line treatment for hypertension, and their use can lead to increased urination. It is essential to weigh the benefits of diuretic therapy against the potential side effects, such as frequent urination, and to monitor patients closely for any adverse effects. In some cases, alternative medications or adjustments to the treatment regimen may be necessary to minimize side effects while maintaining effective blood pressure control 1.
From the Research
Hypertension and Urination
- Hypertension can contribute to bladder dysfunction, which entails symptoms of urinary urgency, frequency, and/or nocturia with or without incontinence 2.
- Patients with hypertension, congestive heart failure, cardiovascular disease, or chronic kidney disease are more likely to experience overactive bladder symptoms, including frequent urination 2.
- The use of short, rapid-acting loop diuretics can exacerbate bladder dysfunction and contribute to impaired quality of life and poor adherence to medication, leading to worsening outcomes 2.
Kidney Function and Hypertension
- Hypertension is closely linked to kidney function, and several subtle abnormalities of renal function are demonstrable in normotensive offspring of hypertensive parents 3.
- Hypertension can cause severe renal failure, and the co-existence of hypertension with renal impairment can greatly worsen the rate of deterioration of renal function 3, 4.
- Effective treatment of hypertension, particularly with converting enzyme inhibitors, can slow the rate of loss of renal function in patients with diabetic nephropathy 3.
Treatment and Management
- Combination antihypertensive therapy is often necessary to achieve target blood pressure goals, and the choice of add-on medication can depend on the individual patient's needs and medical history 5.
- Several antihypertensive agents, including diuretics, ACE inhibitors, and calcium channel blockers, have been shown to reduce hypertension-associated cardiovascular events and improve end-organ damage 6.
- Therapeutic approaches aiming at reducing cardiovascular events and damages induced by hypertension should consider the underlying mechanisms of target organ damage, including oxidative stress, inflammation, and endothelial dysfunction 6.