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Meta-Analysis
. 2012 Nov 14;11(11):CD008167.
doi: 10.1002/14651858.CD008167.pub3.

Blood pressure lowering efficacy of potassium-sparing diuretics (that block the epithelial sodium channel) for primary hypertension

Balraj S Heran  1 , Jenny M H Chen, Josh J Wang, James M Wright
Affiliations
Meta-Analysis

Blood pressure lowering efficacy of potassium-sparing diuretics (that block the epithelial sodium channel) for primary hypertension

Balraj S Heran et al. Cochrane Database Syst Rev. .

Abstract

Background: Potassium-sparing diuretics, which block the epithelial sodium channel (ENaC), are widely prescribed for hypertension as a second-line drug in patients taking other diuretics (e.g. thiazide diuretics) and much less commonly prescribed as monotherapy. Therefore, it is essential to determine the effects of ENaC blockers on blood pressure (BP), heart rate and withdrawals due to adverse effects (WDAEs) when given as a first-line or second-line therapy.

Objectives: To quantify the dose-related reduction in systolic blood pressure (SBP) and diastolic blood pressure (DBP) of ENaC blocker therapy as a first-line or second-line drug in patients with primary hypertension.

Search methods: We searched CENTRAL (The Cochrane Library 2012), MEDLINE (1950 to August 2012), EMBASE (1980 to August 2012) and reference lists of articles.

Selection criteria: Double-blind, randomized, controlled trials in patients with primary hypertension that evaluate, for a duration of 3 to 12 weeks, the BP lowering efficacy of: 1) fixed-dose monotherapy with an ENaC blocker compared with placebo; or 2) an ENaC blocker in combination with another class of anti-hypertensive drugs compared with the respective monotherapy (without an ENaC blocker).

Data collection and analysis: Two authors independently assessed the risk of bias and extracted data. Study authors were contacted for additional information. WDAE information was also collected from the trials.

Main results: No trials evaluating the BP lowering efficacy of ENaC blockers as monotherapy in patients with primary hypertension were identified. Only 6 trials evaluated the BP lowering efficacy of low doses of amiloride and triamterene as a second drug in 496 participants with a baseline BP of 151/102 mm Hg. The additional BP reduction caused by the ENaC blocker as a second drug was estimated by comparing the difference in BP reduction between the combination and monotherapy groups. The addition of low doses of amiloride and triamterene in these trials did not reduce BP. An estimate of the dose-related BP lowering efficacy for ENaC blockers was not possible because of a lack of trial data at higher doses.

Authors' conclusions: ENaC blockers do not have a statistically or clinically significant BP lowering effect at low doses but trials at higher doses are not available. The review did not provide a good estimate of the incidence of harms associated with ENaC blockers.

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Conflict of interest statement

None known.

Figures

1
1
QUOROM flow diagram
2
2
Study flow diagram.
1.1
1.1. Analysis
Comparison 1 Amiloride 2.5 ‐ 5 mg added to HCTZ versus HCTZ alone, Outcome 1 Change in SBP.
1.2
1.2. Analysis
Comparison 1 Amiloride 2.5 ‐ 5 mg added to HCTZ versus HCTZ alone, Outcome 2 Change in DBP.
1.3
1.3. Analysis
Comparison 1 Amiloride 2.5 ‐ 5 mg added to HCTZ versus HCTZ alone, Outcome 3 Total withdrawals due to adverse effects.
2.1
2.1. Analysis
Comparison 2 Triamterene 50 mg added to chlorthalidone versus chlorthalidone alone, Outcome 1 Change in SBP.
2.2
2.2. Analysis
Comparison 2 Triamterene 50 mg added to chlorthalidone versus chlorthalidone alone, Outcome 2 Change in DBP.
2.3
2.3. Analysis
Comparison 2 Triamterene 50 mg added to chlorthalidone versus chlorthalidone alone, Outcome 3 Total withdrawals due to adverse effects.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Andersson 1984 {published data only}
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