Triamterene Enhances the Blood Pressure Lowering Effect of Hydrochlorothiazide in Patients with Hypertension

ABSTRACT BACKGROUND Triamterene, because of its potassium-sparing properties, is frequently used in combination with hydrochlorothiazide (HCTZ) to treat patients with hypertension. By inhibiting the epithelial sodium channel (ENaC) in the cortical collecting duct, triamterene reduces potassium secre...

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Published in:	Journal of general internal medicine : JGIM Vol. 31; no. 1; pp. 30 - 36
Main Authors:	Tu, Wanzhu, Decker, Brian S., He, Zangdong, Erdel, Blake L., Eckert, George J., Hellman, Richard N., Murray, Michael D., Oates, John A., Pratt, J Howard
Format:	Journal Article
Language:	English
Published:	New York Springer US 01-01-2016 Springer Nature B.V
Subjects:	Antihypertensives Blood pressure Blood Pressure - drug effects Collecting duct Diuretics - administration & dosage Dose-Response Relationship, Drug Double-Blind Method Drug Therapy, Combination Drugs Electronic medical records Female Follow-Up Studies Humans Hydrochlorothiazide Hydrochlorothiazide - administration & dosage Hypertension Hypertension - drug therapy Hypertension - physiopathology Hypokalemia Internal Medicine Male Medical electronics Medicine Medicine & Public Health Middle Aged Original Research Patients Potassium Pressure effects Reduction Regression analysis Regression models Retrospective Studies Risk reduction Secretion Sodium Statistical analysis Treatment Outcome Triamterene - administration & dosage HCTZ Propensity Score Triamterene Health Information Exchange Treatment Effect Estimate
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Summary:	ABSTRACT BACKGROUND Triamterene, because of its potassium-sparing properties, is frequently used in combination with hydrochlorothiazide (HCTZ) to treat patients with hypertension. By inhibiting the epithelial sodium channel (ENaC) in the cortical collecting duct, triamterene reduces potassium secretion, thus reducing the risk of hypokalemia. Whether triamterene has an independent effect on blood pressure (BP) has not been well studied. OBJECTIVE To determine if triamterene provides an effect to further lower BP in patients treated with HCTZ. DESIGN We conducted an observational study using electronic medical record data from the Indiana Network for Patient Care. Participants were 17,291 patients with the diagnosis of hypertension between 2004 and 2012. MAIN MEASURES BP was the primary outcome. We compared the BP between patients who were taking HCTZ, with and without triamterene, either alone or in combination with other antihypertensive medications, by using a propensity score analysis. For each medication combination, we estimated the propensity score (i.e., probability) of a patient receiving triamterene using a logistic regression model. Patients with similar propensity scores were stratified into subclasses and BP was compared between those taking triamterene or not within each subclass; the effect of triamterene was then assessed by combining BP differences estimated from all subclasses. KEY RESULTS The mean systolic BP in the triamterene + HCTZ group was 3.8 mmHg lower than in the HCTZ only group ( p < 0.0001); systolic BP was similarly lower for patients taking triamterene with other medication combinations. Systolic BP reduction was consistently observed for different medication combinations. The range of systolic BP reduction was between 1 and 4 mm Hg, depending on the concurrently used medications. CONCLUSIONS In the present study, triamterene was found to enhance the effect of HCTZ to lower BP. In addition to its potassium-sparing action, triamterene’s ability to lower BP should also be considered.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Undefined-1 ObjectType-Feature-3 content type line 23
ISSN:	0884-8734 1525-1497
DOI:	10.1007/s11606-015-3469-1