Potassium Restoration in Hypertensive Patients Made Hypokalemic by Hydrochlorothiazide

Schnaper, H. William; Freis, Edward D.; Friedman, R; Garland, W. Thomas; Hall, Wayne; Hollifield, John W.; Jenkins, Patricia; Marks, Amanda; McMahon, F. Gilbert; Sambol, Nancy C.; Williams, Ronald L.; Winer, Nathaniel

doi:10.1097/00132586-199010000-00059

Cited by 1 publication

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“…However, small studies using triamterene at much higher doses (100-400 mg per day) did show that triamterene had mild antihypertensive properties in comparison to HCTZ or chlorthalidone. 8,11,12,36,37 Consistent with the current findings, a previous study reported that the addition of amiloride lowered systolic BP significantly in African Americans with uncontrolled low-renin hypertension treated with either HCTZ or furosemide and a calcium channel blocker 9 . Differences in the doses of drugs, severity of hypertension, and race may have contributed to the variable conclusions as to the BP effects of triamterene.…”

Section: Discussionsupporting

confidence: 90%

“…A recent Cochrane Collaboration study reported little evidence that triamterene, or for that matter, amiloride, affected BP. 8 Interestingly, among the trials reviewed by the Cochrane report were two randomized trials of triamterene 50 mg plus chlorthalidone 25 mg or 50 mg, with 129 and 141 patients, respectively. 14,15 Neither study found significant BP benefit associated with the addition of triamterene.…”

Section: Discussionmentioning

confidence: 99%

“…Although triamterene lowered BP, purportedly by decreasing sodium reabsorption, there may be an effect of increasing serum potassium levels on BP. 8 ENaC inhibitors, upon reaching the cortical collecting duct, act directly on the channel to affect the transport of sodium. The available direct inhibitors, triamterene and amiloride, have been shown to reduce the activity of ENaC by raising potassium levels.…”

Section: Discussionmentioning

confidence: 99%

“…8 Unlike amiloride and the aldosterone antagonists, whose respective antihypertensive properties have been well documented, 9,10 the BP-lowering effect of triamterene has not been as clearly determined. In the few published studies of triamterene, it failed to show a consistent effect on BP beyond marginal reductions when high doses were used.…”

Section: Introductionmentioning

confidence: 99%

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Triamterene Enhances the Blood Pressure Lowering Effect of Hydrochlorothiazide in Patients with Hypertension

Decker

et al. 2015

J GEN INTERN MED

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BACKGROUND: Triamterene, because of its potassiumsparing properties, is frequently used in combination with hydrochlorothiazide (HCTZ) to treat patients with hypertension. By inhibiting the epithelial sodium channel (ENaC) in the cortical collecting duct, triamterene reduces potassium secretion, thus reducing the risk of hypokalemia. Whether triamterene has an independent effect on blood pressure (BP) has not been well studied. OBJECTIVE: To determine if triamterene provides an effect to further lower BP in patients treated with HCTZ. DESIGN: We conducted an observational study using electronic medical record data from the Indiana Network for Patient Care. Participants were 17,291 patients with the diagnosis of hypertension between 2004 and 2012. MAIN MEASURES: BP was the primary outcome. We compared the BP between patients who were taking HCTZ, with and without triamterene, either alone or in combination with other antihypertensive medications, by using a propensity score analysis. For each medication combination, we estimated the propensity score (i.e., probability) of a patient receiving triamterene using a logistic regression model. Patients with similar propensity scores were stratified into subclasses and BP was compared between those taking triamterene or not within each subclass; the effect of triamterene was then assessed by combining BP differences estimated from all subclasses. KEY RESULTS: The mean systolic BP in the triamterene + HCTZ group was 3.8 mmHg lower than in the HCTZ only group (p<0.0001); systolic BP was similarly lower for patients taking triamterene with other medication combinations. Systolic BP reduction was consistently observed for different medication combinations. The range of systolic BP reduction was between 1 and 4 mm Hg, depending on the concurrently used medications. CONCLUSIONS: In the present study, triamterene was found to enhance the effect of HCTZ to lower BP. In addition to its potassium-sparing action, triamterene's ability to lower BP should also be considered.

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