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

Wanzhu Tu, Brian Decker, Zangdong He, Blake L. Erdel, George J. Eckert, Richard N. Hellman, Michael Murray, John A. Oates, J. Howard Pratt

Research output: Contribution to journalArticle

8 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)30-36
Number of pages7
JournalJournal of General Internal Medicine
Volume31
Issue number1
DOIs
StatePublished - Jan 1 2016

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Triamterene
Hydrochlorothiazide
Blood Pressure
Hypertension
Propensity Score
Potassium
Logistic Models
Epithelial Sodium Channels
Hypokalemia

ASJC Scopus subject areas

  • Internal Medicine

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Triamterene Enhances the Blood Pressure Lowering Effect of Hydrochlorothiazide in Patients with Hypertension. / Tu, Wanzhu; Decker, Brian; He, Zangdong; Erdel, Blake L.; Eckert, George J.; Hellman, Richard N.; Murray, Michael; Oates, John A.; Pratt, J. Howard.

In: Journal of General Internal Medicine, Vol. 31, No. 1, 01.01.2016, p. 30-36.

Research output: Contribution to journalArticle

Tu, Wanzhu ; Decker, Brian ; He, Zangdong ; Erdel, Blake L. ; Eckert, George J. ; Hellman, Richard N. ; Murray, Michael ; Oates, John A. ; Pratt, J. Howard. / Triamterene Enhances the Blood Pressure Lowering Effect of Hydrochlorothiazide in Patients with Hypertension. In: Journal of General Internal Medicine. 2016 ; Vol. 31, No. 1. pp. 30-36.
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AU - Decker, Brian

AU - He, Zangdong

AU - Erdel, Blake L.

AU - Eckert, George J.

AU - Hellman, Richard N.

AU - Murray, Michael

AU - Oates, John A.

AU - Pratt, J. Howard

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AB - 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.

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