Triamterene-thiazide combination: alternative therapy for primary aldosteronism

The hypertension and hypokalemia of primary aldosteronism are related to excessive aldosterone secretion. Spironolactone, an aldosterone antagonist, is used in high doses to treat the disorder, but it may induce a number of side effects that can limit its use. We investigated the feasibility of treating a group of eight patients with hyperaldosteronism with a triamterene-thiazide combination to induce volume depletion and increase serum potassium concentration. All patients responded with normalization or near normalization of blood pressure. Serum potassium could be maintained within the normal range with or without potassium supplements in all but one patient. The effectiveness of the therapy suggests that thiazide-triamterene treatment may offer an alternative in some patients with primary aldosteronism who do not tolerate spironolactone.