[The clinical spectrum of potassium-sparing diuretics]

The role of potassium-sparing diuretics in the treatment of hypertension is discussed. The results of two newer case-control studies showing both an increased risk for sudden cardiac death in patients receiving non-potassium-sparing diuretics compared to those receiving potassium-sparing diuretics are presented. As a consequence of these studies thiazides should be given only at a low dose or in combination with a potassium-sparing agent. Data from several large intervention trials in elderly patients with hypertension show that treatment of high blood pressure with potassium-sparing diuretics is clearly beneficial since cerebral and cardiac events are both significantly reduced. Finally, potassium-sparing diuretics, especially spironolactone, play an important role in controlling high blood pressure in patients with primary aldosteronism. The presentation of a case report demonstrates, that development of resistance toward medical treatment may be due to elevated aldosterone levels and suppressed plasma renin activity and that the addition of spironolactone efficiently reduces elevated blood pressure values in this condition.