The long-term treatment of hypertension with thiazide diuretics

1 The influence of spironolactone 50 mg and 100 mg daily, triamterene 100 mg and 200 mg daily, potassium chloride 32 mmol and 64 mmol daily and placebo on plasma potassium and other variables was examined in a random crossover study of nine hypertensive patients taking bendrofluazide 10 mg daily.2 Spironolactone and triamterene had significant and parallel dose-response curves for plasma potassium, with a relative potency for triamterene:spironolactone of 0.25:1, significantly lower than the accepted 0.5:1 ratio. These drugs also lowered serum sodium, bicarbonate and body weight, and increased serum urea and creatinine. 3 Potassium chloride increased plasma potassium above placebo values, but the dose-response was not significant and was not parallel with those of the potassium-sparing drugs. Seven of nine patients remained hypokalaemic despite treatment with 64 mmol potassium chloride daily. 4 The relative expense, convenience and toxicity of the potassium-sparing drugs should be assessed at equivalent doses, namely spironolactone 50 mg:triamterene 200 mg:amiloride 20 mg. Potassium chloride does not correct moderate diuretic-induced hypokalaemia even at doses of 64 mmol daily.

Section: Introductionmentioning

confidence: 99%

Relative potency of spironolactone, triamterene and potassium chloride in thiazide‐induced hypokalaemia.

Jackson¹,

Ramsay²,

Wakefield³

1982

“…Bumetanide has been shown to cause a decreased renal clearance of urate (Davies, Lant, Millard, Smith, Ward & Wilson, 1974 This study has shown that bumetanide causes only a small temporary decrease in systolic blood pressure in the erect position, possibly related to the temporary decrease in extracellular fluid and plasma volumes that occurs during diuretic therapy (Wilson & Freis, 1959). It is therefore similar to frusemide in its lack of antihypertensive action (Healy et al, 1970), and differs from the thiazide diuretics and chlorthalidone, which have a sustained antihypertensive effect (Beevers, Hamilton & Harpur, 1971). …”

Section: Discussionmentioning

confidence: 95%

Lack of effect of bumetanide on body potassium content in hypertension.

Murchison¹,

Bewsher²

1975

1Twelve patients with mild hypertension were treated with bumetanide for a six-month period. No evidence was found of hypokalaemia or decreased total exchangeable potassium in subjects with or without additional potassium supplements. 2 Bumetanide was well tolerated by all patients. It caused hyperuricaemia but no episodes of gout occurred. Minor abnormalities of liver function were noted. 3 Bumetanide did not have a sustained antihypertensive action.

“…The incidence of hyperuricaemia in hypertensive patients taking thiazides is stated to be about 20% (Beevers, Hamilton & Harpur, 1971) although a higher incidence has been reported (Breckenridge, 1966). In some patients acute gout develops with commencement of treatment and frequently occurs in susceptible patients who continue to take thiazides.…”

Section: Introductionmentioning

confidence: 99%

A double‐blind comparison of the effects of hydrochlorothiazide and tienylic acid (a diuretic with uricosuric properties) in hypertension.

Gillies¹,

Morgan²

1978

1. A double‐blind comparison of the effect of tienylic acid and hydrochlorothiazide on blood pressure was made in patients with moderate hypertension. 2. The antihypertensive effect of 500 mg tienylic acid was comparable to 100 mg hydrochlorothiazide; mean decrease in supine blood pressure after 6 weeks treatment was 20/12 mmHg with tienylic acid and 17/9 mmHg with hydrochlorothiazide. Onset of antihypertensive action was within 1 week and was associated with significant weight loss. 3. Tienylic acid caused a marked decrease in serum uric acid to a mean of 0.18 mmol/1 (n = 11, P less than 0.001), this persisted through the treatment period and returned to placebo values 1 week after treatment ceased. Some patients had uric acid crystaluria and some had post‐treatment uric acid levels higher than on placebo. 4. Tineylic acid and hydrochlorothiazide caused mild hypokalemia and alkalosis with proportional decrease in plasma chloride. 5. Blood urea and serum creatinine rose with both drugs and there was an unimportant decline in plasma sodium. 6. Tienylic acid is an effective antihypertensive agent with powerful uricosuric action and appears relatively free of side effects. Further studies are necessary to determine optimal dosage regimes and long term safety.