Summary
After a run-in period of 8 weeks on a regimen of hydrochlorothiazide (HCT, median dosage 75 mg/day), patients with essential hypertension were randomly allocated to continued hydrochlorothiazide therapy (Group I) or additional treatment with amiloride (Group II, median dosage 15 mg/day, or 5 mg per 25 mg hydrochlorothiazide) for the following 12 weeks. Thereafter all the patients were changed to treatment with a fixed combination tablet containing 5 mg amiloride and 50 mg hydrochlorothiazide (Moduretic), keeping the thiazide dosage unchanged for an additional 12 weeks. In Group I patients there was no change in plasma potassium, total body potassium content or the renin-angiotensin-aldosterone system during the 12 weeks on HCT. When the treatment was changed to Moduretic, significant increases were found of 10% in plasma potassium and 3% in total body potassium content. No important stimulation of the renin-angiotensin-aldosterone system was found. In Group II patients addition of an average of 15 mg amiloride to the hydrochlorothiazide treatment led to significant increases in plasma potassium and total body potassium content of approximately 15% and 4%, respectively. There was also a significant increase in the plasma concentrations of renin, angiotensin II and aldosterone. Reducing the average dose of amiloride to 7.5 mg/day by use of Moduretic did not lead to decrease in plasma potassium or total body potassium content. Plasma concentrations of renin, angiotensin II, and aldosterone were decreased, but the individual changes varied markedly and no significant overall change was found.
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References
Davidson C, Gillebrand IM (1973) Use of amiloride as a potassium conserving agent in severe cardiac disease. Br Heart J 35: 456–461
Edmonds CJ, Jasani B (1972) Total-body potassium in hypertensive patients during prolonged diuretic therapy. Lancet 2: 8–12
George CF, Breckenridge AM, Dollery CT (1973) Comparison of the potassium-retaining effects of amiloride and spironolactone in hypertensive patients with thiazide-induced hypokalaemia. Lancet 2: 1288–1291
Giese J, Damkjær Nielsen M, Kappelgaard AM (1981) Concentrations of active and inactive renin in human plasma: Concepts and methodology. In: Sambhi MP (ed) Heterogeneity of renin and renin substrate. Elsevier/North Holland, Amsterdam, pp 205–213
Hicks CR (1973) Fundamental concepts in the design of experiments, 2edn. Holt, Rinehart and Winston, New York
Ibsen H (1974) The effect of potassium chloride and spironolactone on thiazide-induced potassium depletion in patients with essential hypertension. Acta Med Scand 196: 21–26
Kappelgaard AM, Nielsen MD, Giese J (1976) Measurement of angiotensin II in human plasma: Technical modifications and practical experience. Clin Chim Acta 67: 299–306
Lund JO, Damkjær Nielsen M, Giese J, Gammelgaard PA, Hasner E, Hesse B, Tønnesen KH (1980) Localization of aldosterone-producing tumours in primary aldosteronism by adrenal and renal vein catheterization. Acta Med Scand 207: 345–351
Multicenter Diuretic Cooperative Study Group (1981) Multiclinic comparison of amiloride, hydrochlorothiazide plus amiloride in essential hypertension. Arch Intern Med 141: 482–486
Pearce VR, Antcliff AC, Beevers DG, Hamilton M (1978) Total exchangeable potassium in response to amiloride. Postgrad Med J 54: 533–537
Ramsay LE, Hettiarachchi J, Fracer R, Morton JJ (1980) Amiloride, spironolactone, and potassium chloride in thiazidetreated hypertensive patients. Clin Pharmacol Ther 27: 533–543
Svendsen UG, Ibsen H, Rasmussen S, Leth A, Nielsen MD, Dige-Petersen H (1983) Effects of amiloride on plasma and total body potassium, blood pressure, and the renin-angiotensin-aldosterone system in thiazide-treated hypertensive patients. Clin Pharmacol Ther 34: 448–453
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Svendsen, U.G., Ibsen, H., Rasmussen, S. et al. Effects of combined therapy with amiloride and hydrochlorothiazide on plasma and total body potassium, blood pressure, and the renin-angiotensin-aldosterone system in hypertensive patients. Eur J Clin Pharmacol 30, 151–156 (1986). https://doi.org/10.1007/BF00614293
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DOI: https://doi.org/10.1007/BF00614293