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Harold W. Schnaper, MD; Edward D. Freis, MD; Richard G. Friedman, MD; W. Thomas Garland, MD; W. Dallas Hall, MD; John Hollifield, MD; Adesh K. Jain, MD; Patricia Jenkins, MD; Allan Marks, MD; F. Gilbert McMahon, MD; Nancy C. Sambol, PharmD; Roger L. Williams, MD; Nathaniel Winer, MD

Arch Intern Med. 1989;149(12):2677-2681.

Abstract
• 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.

(Arch Intern Med. 1989;149:2677-2681)

Author Affiliations
From the Center for Aging, University of Alabama in Birmingham (Dr Schnaper); Veterans Administration Medical Center, Washington, DC (Dr Freis); San Diego (Calif) Centre for Stress Studies (Dr Friedman); Margo Morgan Research Center, New Orleans, La (Dr Garland); Emory University School of Medicine, Atlanta, Ga (Dr Hall); Hypertension Center of Nashville (Tenn) (Dr Hollifield); Clinical Research Center Inc, New Orleans (Drs Jain and McMahon); Urban Cardiology Research Center, Garwyn Medical Center, Baltimore, Md (Dr Jenkins); Temple University Hospital, Philadelphia, Pa (Dr Marks); Drug Studies Unit, University of California, San Francisco (Drs Sambol and Williams); and University of Missouri School of Medicine, Kansas City (Dr Winer).

Footnotes
Accepted for publication July 17, 1989.

Presented as a scientific exhibit at the 40th Annual Scientific Assembly of the American Academy of Family Physicians, New Orleans, October 3-6,1988. Reprint requests to Center for Aging, CHSB 201, University of Alabama at Birmingham, Birmingham, AL 35294 (Dr Schnaper).

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