If a patient is already on another type of diuretic, do we make a switch to a thiazide diuretic post stroke?
A. If the patient is on spironolactone as a treatment for heart failure or LVH or renal disease then this should not be switched as aldosterone antagonists have been shown to lower mortality in HF by 27% whereas thiazides have not. They also regress LVH and prevent progressive proteinuria, whereas thiazides do not. Loop diuretics have not been shown to reduce stroke. If a loop diuretic is being used for volume control in patients with heart failure, they should not be switched as the thiazide diuretic switch would likely lead to decompensated heart failure. If the patient has none of the aforementioned situations then a switch to a thiazide diuretic can be made after due consultation with the patients primary care physician. Q.
