Diuretic regimens in essential hypertension. A comparison of hypokalemic effects, BP control, and cost

Abstract

Intolerable side effects and hypokalemia during thiazide treatment of hypertension frequently necessitate a change in diuretic regimen. The hypokalemic effects, effectiveness in controlling BP, and cost of several alternate diuretic regimens were evaluated. Prevalences of serum K+ values less than 3.5 mEq/L were as follows for the various regimens: hydrochlorothiazide, 50 mg daily, 11.0% (n = 500); chlorthalidone, 25 mg daily, 8.1% (n = 37); triamterene, 100 mg, plus hydrochlorothiazide, 50 mg daily, 5.3% (n = 357); hydrochlorothiazide, 25 mg daily, 2.2% (n = 183); and furosemide, 40 mg daily, 3.5% (n = 284). In paired studies comparing hydrochlorothiazide with alternate diuretic regimens, potassium conservation was comparable with furosemide, the triamterene/hydrochlorothiazide combination, the spironolactone/hydrochlorothiazide combination, and adding potassium, 37 mEq daily. All alternate diuretic regimens were as effective as hydrochlorothiazide in controlling BP. Furosemide reduced serum glucose and calcium levels compared with hydrochlorothiazide. When these factors and costs are considered, furosemide appears to be the most cost-effective alternative in patients with hypertension in whom intolerable side effects or hypokalemia develops while taking hydrochlorothiazide.

Comparative efficacy and safety of aliskiren, an oral direct renin inhibitor, and ramipril in hypertension: a 6-month, randomized, double-blind trial

“…The incidence of adverse events was lower in both of these groups than in patients who continued or stopped ramipril therapy. Analysis of biochemical laboratory parameters during the active-controlled treatment period or the withdrawal period showed that approximately 5% of patients in each group had potassium levels under 3.5 mmol/l, which is not unexpected with HCTZ-containing treatment regimens [31,32]. Few patients in either group exhibited potassium levels over 5.5 mmol/ (< 2%) or !…”

Drug Therapy for Resistant Hypertension: Simplifying the Approach

“…The dose of HCTZ can be increased or the HCTZ could be replaced by 25 mg of the more potent thiazide‐like diuretic chlorthalidone. 19,20 With either intervention, the potassium level must be monitored and addition of a potassium‐sparing diuretic should be considered 30 …”

“…Unfortunately, studies assessing higher doses of amiloride are not likely to be performed. Similarly, the dose of triamterene included in triamterene/HCTZ combination pills (37.5/25 mg or 75/50 mg) are often inadequate to protect the serum potassium level 30 …”

Influence of West African Ethnicity and Gender on Beta-Cell Function and Insulin Sensitivity in Essential Hypertensives Treated with Hydrochlorothiazide and Hydrochlorothiazide-lisinopril Combination

“…[24] This lack of significant reduction in potassium levels may reflect the low-renin, volume-dependent nature of hypertension in Nigerians, which may alter K+ homeostasis in response to therapy in blacks[25] or the relatively higher salt/potassium intake of the subjects studied.…”