Key result
Adding triamterene or higher-dose potassium restores serum potassium faster than low-dose potassium with hydrochlorothiazide.
RCT (n=252)
Randomized
Among 447 hypertensive patients, most with a history of diuretic-induced hypokalemia, 252 developed diuretic-induced hypokalemia while receiving hydrochlorothiazide, 50 mg/d. In a randomized study we evaluated the efficacy of three drug regimens in restoring potassium levels while maintaining blood pressure control: hydrochlorothiazide (50 mg/d) plus potassium supplement (20 mmol/d); hydrochlorothiazide (50 mg/d) plus potassium supplement (40 mmol/d); or hydrochlorothiazide (50 mg/d) with triamterene (75 mg/d) in one combination tablet. In all groups, mean serum levels of potassium rose within 1 week and showed no further change thereafter. However, the hydrochlorothiazide/triamterene and hydrochlorothiazide plus 40 mmol of potassium regimens were significantly more effective in restoring serum potassium levels than was the hydrochlorothiazide plus 20 mmol of potassium regimen. A significant increase in magnesium levels was observed only in the group treated with the hydrochlorothiazide/triamterene combination. Each regimen provided continued control of mild to moderate hypertension.
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Harold W. Schnaper (1989) conducted an RCT in Diuretic-induced hypokalemia in mild to moderate hypertension (n=252). Hydrochlorothiazide plus triamterene combination tablet or hydrochlorothiazide plus high-dose potassium supplement vs. Hydrochlorothiazide 50 mg/d plus potassium supplement 20 mmol/d was evaluated on Restoration of serum potassium levels while maintaining blood pressure control. Hydrochlorothiazide 50 mg/d plus triamterene 75 mg/d or potassium 40 mmol/d restored serum potassium significantly better than hydrochlorothiazide plus potassium 20 mmol/d within 1 week.
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