[Diuretics, potassium depletion and ventricular hyperexcitability]

Area of Science:

• Cardiology
• Pharmacology
• Nephrology

Background:

• Moderate essential hypertension requires effective and safe treatment.
• Diuretics are common antihypertensive agents but can affect electrolyte balance.
• Understanding the potassium risk associated with different diuretics is crucial.

Purpose of the Study:

• To compare the efficacy and safety of hydrochlorothiazide versus a combination of altizide and aldactone in treating moderate essential hypertension.
• To assess the impact of these treatments on blood pressure, plasma potassium, and ventricular premature contractions.

Main Methods:

• Prospective randomized study with 28 patients.
• One-year treatment with either hydrochlorothiazide (25-50 mg/day) or altizide (15 mg) + aldactone (25 mg) daily.
• Monitoring of blood pressure, plasma potassium, exchangeable potassium, ventricular premature contractions (Holter), and plasma magnesium.

Main Results:

• Both treatment groups achieved significant blood pressure normalization (p < 0.001).
• Plasma potassium decreased slightly with altizide-aldactone (NS) and hydrochlorothiazide (p < 0.01).
• No significant changes in total potassium pool or correlation between hypokalemia and ventricular arrhythmias were observed.

Conclusions:

• Both hydrochlorothiazide and the altizide-aldactone combination effectively manage moderate essential hypertension.
• The risk of significant potassium imbalance with these diuretics appears low, especially with low doses or combined therapy.
• Further risk mitigation is possible using potassium-sparing agents or alternative antihypertensive classes.