Long-Term Electrolyte Effects during Initiation of Antihypertensive Therapy with Amlodipine or Hydrochlorothiazide in Diabetic Nigerians

Abstract

Information is scarce regarding the effects of amlodipine or hydrochlorothiazide therapy on serum and urine electrolyte profiles in hypertensive Nigerians with type 2 diabetes mellitus. Therefore, to evaluate whether amlodipine or hydrochlorothiazide would be preferable to initiate treatment, we randomized 40 newly diagnosed hypertensive subjects with controlled type 2 diabetes mellitus aged 43-68years to amlodipine and hydrochlorothiazide treatment groups of 20 patients each (10 males, 10 females), and they were treated respectively, with amlodipine 10mg and hydrochlorothiazide 25mg, both drugs being given once daily for 48 weeks. Body mass index, blood pressure, 24h urine volume, serum and urine electrolytes were assessed at baseline and at the end of weeks 1, 3, 6, 12, 24, 36 and 48. The two drugs significantly reduced blood pressure, though the effect of amlodipine was significantly greater compared with that of hydrochlorothiazide (P < 0.01). Diuresis was significant in hydrochlorothiazide group (P < 0.01). Observed male/female serum Na + loss was 9.18±2.32/10.90±2.50 and 13.30±1.34/15.10±1.77mmol/L for amlodipine and hydrochlorothiazide subgroups, respectively. There was a parallel significant (P < 0.05) natriuresis. Significant (P < 0.05) hypokalemia occurred in hydrochlorothiazide subgroups and overall male/female serum K + loss was 0.10/0.08 and 0.16/0.24mmol/L for amlodipine and hydrochlorothiazide, respectively. However, there was no significant parallel kaliuresis. Significant (P < 0.05) disproportionate hypochloremia occurred in all subgroups, so also was the parallel chloriuria. By providing effective blood pressure control and beneficial biochemical effects, amlodipine therapy appears suitable for treatment of hypertension in these diabetic patients. Similarly, low dose hydrochlorothiazide therapy, which seems to have more marked effects in females, appears to have moderate biochemical complications in these patients and is, therefore, a logical alternative to substitute for or add to amlodipine therapy.

Antihypertensive drug prescription patterns and their impact on outcome of blood pressure in Ethiopia: a hospital-based cross-sectional study

“…Inappropriate provision of medications could also lead to extra expense incurred to the patient due to ineffective treatment and adverse drug reactions. 6 Copayment for antihypertensives might also contribute for poor disease outcome. 7 The lack of improvement and appearance of untoward side effects with the prescribed medication could result in distrust between the patient and the clinician 8 , 9 Infective drugs also provoke the physicians to frequently change the regimen and dose, thereby leading to fluctuation in patients’ BP.…”

Adverse Events Profiles during Initiation of Treatment with Amlodipine or Hydrochlorothiazide in Type 2 Diabetic Nigerians with Essential Hypertension

“…In particular and in contrast with some other reports (16)(17), it is remarkable that no patient in the AML group developed pedal edema. This may be explained by the fact that the patients were salt-sensitive and had adequate natriuresis and diuresis (2,5,(10)(11)(12)(13).…”

“…For example, diuretics such as HCZ may cause polyuria, aggravating the disease condition; or induce impotence which may adversely affect adherence. AML may be associated with headache, palpitations, ankle edema or polyuria, with negative implications for adherence (1,(5)(6). In fact, recent studies reveal that one of the problems militating against adequate control of hypertension is adverse effects of medications such as orthostatic hypotension, dizziness, cough, headache, frequent urination and impotence (1,7).…”

Uses of Monotherapy and Combination of Antihypertensive Drugs for Hypertensive Patients with Type-2 Diabetes

“…Uncontrolled blood pressure (UBP) is an independent risk factor leading to enormous complications and mortalities secondary to HTN. Inappropriate provision of medications could also lead to extra expense incurred to the patient due to ineffective treatment and adverse drug reactions [14]. As a component of pharmacoepidemiological techniques, prescribing pattern surveys provide an unbiased picture of prescribing habits and help identify suboptimal prescribing patterns for further evaluation.…”