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[Diuretics, potassium depletion and ventricular hyperexcitability]
S Witchitz1, F Paillard, S Gryner
1Hôpital de Jour pluridisciplinaire, Paris.
Insights
This study compared two hypertension treatments, finding both effective in lowering blood pressure. While hydrochlorothiazide caused a slight potassium drop, neither diuretic posed a significant potassium risk in moderate essential hypertension.
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.
Abstract:
This prospective randomized study involved 28 patients with moderate essential hypertension who for one year, took either hydrochlorothiazide [Esidrex (E) 25-50 mg per day] or a combination of altizide 15 mg--aldactone 25 mg [Aldactazine (A) 1 or 2 tablets per day] without potassium supplements. Blood pressure, plasma potassium, exchangeable potassium, ventricular premature contractions measured by Holter and plasma magnesium were monitored. Blood pressure was brought to normal in both treatment groups (p < 0.001). Plasma potassium fell by 0.19 mmol/l with A (NS) and 0.35 mmol/l (p < 0.01) with E. Changes in potassium pool were not significant. There was a non-significant reduction in the number of ventricular premature contractions in both groups. There was no correlation between the few cases of frank hypokaliema, fall in potassium pool and complex ventricular premature contractions. A review of the literature offers no solid arguments suggestive of significant potassium risk associated with these diuretics. Any such risk can be eliminated by the use of low doses, combined if necessary with a potassium-sparer or a hypotensive agent of another group.