Skip to main content
SpringerLink
Log in

Potassium Supplements and Potassium-Sparing Diuretics

A Review and Guide to Appropriate Use

  • Practical Therapeutics
  • Published:
Drugs Aims and scope Submit manuscript

An Erratum to this article was published on 01 March 1994

Summary

Epidemiological and clinical studies suggest that low dietary potassium intake may have an important role in determining the development of diseases such as hypertension, and perhaps even stomach cancer, and that increased potassium intake may have beneficial effects in several other conditions Dietary adjustment or active potassium supplementation has been suggested as a natural less costly and safe method of increasing potassium levels, although active supplementation with tablets or solutions is not recommended in healthy people with normal serum potassium levels. However, increasing dietary potassium intake in the elderly and in patients with renal impairment must be considered with caution.

Diuretics have a long established role in the management of hypertension and heart failure. There is no convincing evidence to suggest that the small reduction in plasma potassium levels associated with low dose thiazide and loop diuretic therapy needs to be routinely prevented by the use of potassium-sparing drugs. In non-digitalised patients little association has been found between mild diuretic-induced hypokalaemia and arrhythmias. Thus, the routine prophylactic use of potassium-sparing diuretics in combination with non-potassium-retaining diuretics for the treatment of hypertension and oedematous states is not justified. Based on current evidence, treating all patients whose serum potassium level decreases below 3 mmol/L is recommended, although for certain patients at particular risk of hypokalaemia, levels may need to be maintained above 3.5 mmol/L.

In overt hypokalaemia, several therapeutic options are available to the clinician. These include increased consumption of potassium-rich foods, the use of salt substitutes, medicinal potassium supplementation or distal tubular (potassium-sparing) diuretics.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Acheson RM, Williams DRR. Does consumption of fruit and vegetables protect against stroke? Lancet 1: 1191–1193, 1983

    Article  CAS  PubMed  Google Scholar 

  • Addison WLT. The use of sodium chloride, potassium chloride, sodium bromide and potassium bromide in cases of arterial hypertension which are amenable to potassium chloride. Canadian Medical Association 18: 281–285, 1928

    CAS  Google Scholar 

  • Amery A, Birkenhager W, Brixko P, Bulpitt C, Clement D, et al. Mortality and morbidity results from the European working party on high blood pressure in the elderly trial. Lancet 1: 1349–1354, 1985

    Article  CAS  PubMed  Google Scholar 

  • Andersch, B, Hahn, L, Andersson, M, Isaksson, B. Body water and weight in patients with premenstrual tension. British Journal Obstetrics and Gynaecology 85: 546–550, 1978

    CAS  Google Scholar 

  • Arroyo V, Gines A. Therapy with diuretics in hepatic disease with edema and the management of refractory ascites. In Reyes (Ed.) Diuretics: clinical pharmacology and uses in cardiovascular medicine, nephrology and hepatology: 9, pp. 619–652, Verlag, Stuttgart, 1992

    Google Scholar 

  • Aslaksen K, Falk V. Spironolactone in the treatment of premenstrual tension: a double-blind study of sprionolactone versus bendroflumethiazide and placebo. Current Therapeutic Research 49: 120–130, 1991

    Google Scholar 

  • Aurell A, Rudin A. Effect of captopril on blood pressure, renal function, the electolyte balance and the renin-angiotensin system in Banter’s syndrome. Nephron 33: 274–278, 1983

    Article  CAS  PubMed  Google Scholar 

  • Baba W, Tudhope G, Wilson G. Triamterene, a new diuretic drug. British Medical Journal 2: 756–760, 1962

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Barden AE, Vandogen R, Beilin LJ, Margetts B, Rogers R Potassium supplementation does not lower blood pressure in normotensive women. Journal of Hypertension 4: 339–343, 1986

    Article  CAS  PubMed  Google Scholar 

  • Barth JH, Cherry CA, Wojnarowska F, Dawber PRP. Spironolactone is an effective and well tolerated systemic antiandrogen therapy for hirsute women. Journal of Clinical Endocrinology and Metabolism 68: 966–970, 1989

    Article  CAS  PubMed  Google Scholar 

  • Bartter FC, Gill, JR, Frolich JC, Bowden RE, Hollifield JW, et al. Prostaglandins are overporduced by the kidneys and mediate hyperreninemia in Bartter’s syndrome. Transactions of the Association of American Physcians 89: 77–91, 1976

    CAS  Google Scholar 

  • Bartter FC, Pronove P, Gill JR, MacCardle RC, Diller E. Hyperplasia of the juxtaglomerular complex with hyper aldosteronism and hypokalemic alkalosis. A new syndrome. American Journal of Medicine 33: 811–28, 1962

    Article  CAS  PubMed  Google Scholar 

  • Bastl CP, Hayslett JR The cellular action of aldosterone in target epithelia. Kidney International 42: 250–264, 1992

    Article  CAS  PubMed  Google Scholar 

  • Bayer AJ, Farag R, Browne S, Pathy MSJ. Plasma electrolytes in elderly patients taking fixed doses combination diuretics. Postgraduate Medical Journal 62: 159–162, 1986

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Beevers DG, Hamilton M, Harpur JE. The long-term treatment of hypertension with thiazide diuretics. Postgraduate Medical Journal 47: 639–643, 1971

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Ben-Ishay D, Engelman K. Bioavailability of potassium from a slow-release tablet. Clinical Pharmacology and Therapeutics 14: 250–258, 1973

    Article  CAS  PubMed  Google Scholar 

  • Bourke E, Delaney V. Bartter’s syndrome — a dilemma of cause and effect. Nephron 27: 177–186, 1981

    Article  CAS  PubMed  Google Scholar 

  • Bourke E. Diuresis and serum electrolytes levels: a comparative clinical study of bumetamide (‘Burinex’), Bumetamide-KCl (‘Burinex-K’) and frusemide. Clinical Trials Journal 11: 9–13, 1974

    Google Scholar 

  • Bull NL, Buss DH. Contributions of foods to potassium intake. Abstract. The Nutrition Society 39: 31A, 1980

    CAS  Google Scholar 

  • Bulpitt CJ, Ferner G, Lewis PJ, Daymond M, Bulpitt PF, et al. Potassium supplementation fails to lower blood pressure in hypertensive patients receiving a potassium losing diuretic. Annals of Clinical Research 17: 126–130, 1985

    CAS  PubMed  Google Scholar 

  • Burchell HB. Dilemmas in potassium therapy. Circulation 47: 1144, 1973

    Article  CAS  PubMed  Google Scholar 

  • Burke BM, Cunliffe WJ. Oral sprionolactone therapy for female patients with acne, hirsutism or androgenic alopecia. Correspondence. British Journal of Dermatology 112: 124–125, 1985

    Article  CAS  PubMed  Google Scholar 

  • Burstyn P, Hornall D, Watchorn C. Sodium and potassium intake and blood pressure. British Medical Journal 2: 537–539, 1980

    Article  Google Scholar 

  • Cappuccio FP, Markandu ND, Sagnella GA, MacGregor GA. Sodium restriction lowers high blood pressure through a decreased response of the renin system — direct evidence using saralasin. Journal of Hypertension 3: 243–247, 1985

    Article  CAS  PubMed  Google Scholar 

  • Cappuccio FP, MacGregor GA. Does potassium supplementation lower blood pressure? A meta-analysis of published trials. Journal of Hypertension 9: 465–473, 1991

    Article  CAS  PubMed  Google Scholar 

  • Carlsen JE, Kober L, Torp-Peterson C, Johansen P. Relation between dose of bendrofluazide, antihypertensive effect and adverse biochemical effects. British Medical Journal 300: 975–978, 1990

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Cheitlin MD, Byrd R, Benowitz EL, Modin G. Amiloride improves hemodynamics in patients with chronic congestive heart failure treated with chronic digoxin and diuretics. Cardiovascular Drugs and Therapy 5: 719–726, 1991

    Article  CAS  PubMed  Google Scholar 

  • Chen WT, Brace RA, Scott JA, Anderson DK, Haddy FJ. The mechanism of the vasodilator action of potassium. Proceedings of the Society of Experimental Biology and Medicine 140: 820, 1972

    Article  CAS  Google Scholar 

  • Clark E. Spironolactone therapy and gynecomastia. Journal of American Medical Association 193: 163–164, 1965

    Article  CAS  Google Scholar 

  • Clementsen A, Hoegholm C, Hansen L, Damkjaer M, Christensen P, et al. Bartter’s syndrome — treatment with potassium, spironolactone and ACE-inhibitor. Journal of Medicine 225: 107–110, 1989

    CAS  Google Scholar 

  • Cohen JJ, Gennari FJ, Harrington JT. Disorders of potassium metabolism In Brenner & Rector Jr (Eds) The kidney, p. 908, WB Saunders Co., Philadelphia, 1981

    Google Scholar 

  • Cohn JN, Johnson G, Ziesche S, Cobb F, Francis G, et al. A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive failure. New England Journal of Medicine 325: 303–310, 1991

    Article  CAS  PubMed  Google Scholar 

  • Committee on Safety of Medicines. Current problems. Spironolactone. Correspondence. 21: January, 1988

    Google Scholar 

  • Consensus Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure: results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). New England Journal of Medicine 316, 1429–1435, 1987

    Article  Google Scholar 

  • Cooper I. Potassium supplementation during diuretic therapy. Current Therapeutic Research 17: 555–563, 1975

    CAS  PubMed  Google Scholar 

  • Coote JH. Pharmacological control of altitude sickness. Trends in Pharmacological Sciences 12: 450–455, 1991

    Article  CAS  PubMed  Google Scholar 

  • Corvol P, Claire M, Oblin ME, Geering K, Rossier B. Mechanism of the antimineralocorticoid effects of spirolactones. Kidney International 20: 1–6, 1981

    Article  CAS  PubMed  Google Scholar 

  • Cranston WI, Juel-Jensen BE, Semmence AM, Handfield Jones RPC, Forbes JA, et al. Effects of oral diuretics on raised arterial pressure. Lancet 2: 966–970, 1963

    Article  CAS  PubMed  Google Scholar 

  • Cumming DC, Yang JL, Rebar RW, Yen SSC. Treatment of hirsutism with spironolatctone. Journal of American Medical Association 247: 1295–1298, 1982

    Article  CAS  Google Scholar 

  • Dahlof B, Lindholm LH, Hansson L, Schersten B, Ekbom T, et al. Morbidity and mortality in the Swedish trial in old patients with hypertension (STOP-Hypertension). Lancet 338: 1281–1285, 1991

    Article  CAS  PubMed  Google Scholar 

  • Dall JLC. Guidelines for rational diuretic use in the elderly Drugs 31 (Suppl. 4): 202–206, 1986

    PubMed  Google Scholar 

  • Dargie HJ, Cleland JGF, Leckie BJ, Inglis CG, East BW, et al. Relation of arrythmias and electrolyte abnormalities to survival in patients with severe chronic heart failure. Circulation 75 (Suppl. IV): 98–107, 1987

    Google Scholar 

  • DeCarvalho J, Emery A, Frohlich E. Spironolactone and triamterene in volume dependent essential hypertension. Clinical Pharmacology and Therapeutics 27: 53–56, 1980

    Article  CAS  PubMed  Google Scholar 

  • Denton D. The hunger for salt: an anthropological, physiological and medical analysis, Springer-Verlag, Berlin, Heidelberg & New York, 1982

    Google Scholar 

  • Dietz R, Schomig A, Rascher W, Strasser R, Ganten U, et al. Partial replacement of sodium by potassium in the diet restores impaired noradrenaline inactivation and lowers blood pressure in stroke-prone hypertensive rats. Clinical Science 61 (Suppl.): 69s–71s, 1981

    Article  CAS  PubMed  Google Scholar 

  • Duchin KL, Hutcheon D. Comparison of bumetanide and hydrochlorothiazide on renal potassium and hydrogen ion exchange. Journal of Clinical Pharmacology 17: 453–460, 1977

    Article  CAS  PubMed  Google Scholar 

  • Dunn FG, Kerr IC, McQueen JJ, Thomson RM. Comparison of intravenous bumetamide and frusemide during open heart surgery. Posdgraduate Medical Journal 51 (Suppl. 6): 72, 1975

    Google Scholar 

  • Dyckner T, Wester PO. Diuretic treatment and magnesium loss. Abstract. Acta Medica Scandinavia 209 (Suppl.): 647, 1981

    Google Scholar 

  • Dyckner T, Wester PO. Potassium/magnesium depletion in patients with cardiovascular disease. American Journal Medicine 82 (Suppl. 3A): 11–17, 1987

    Article  CAS  Google Scholar 

  • Editorial. Spironolactone: no longer for hypertension. Drug and Therapeutics Bulletin 26: 88–89, 1985

    Google Scholar 

  • Editorial. Potassium disorders and cardiac arrhythmias. Drug & Therapeutics Bulletin 29: 73–75, 1991a

    Google Scholar 

  • Editorial. Routine use of potassium sparing diuretics. Drug and Therapeutics Bulletin 29: 85–87, 1991b

    Google Scholar 

  • Editorial. Managing heart failure — home or hospital? Drug and Therapeutics Bulletin 30: 61–63, 1992

    Google Scholar 

  • Flamenbaum W. Diuretic use in the elderly: potential for diuretic-induced hypokalaemia. American Journal of Cardiology 57: 38A–43A, 1986

    Article  CAS  PubMed  Google Scholar 

  • Fournier G, Pfaff-Poulard C, Methani K. Rapid correction of hypokalaemia via the oral route. Lancet 2: 163, 1987

    Article  CAS  PubMed  Google Scholar 

  • Freis ED. The cardiotoxicity of thiazide diuretics: review of the evidence. Journal of Hypertension 8 (Suppl. 2): S23–S32, 1990

    Article  CAS  PubMed  Google Scholar 

  • Fujita T, Sato Y. Natriuretic and antihypertensive effects of potassium in DOCA-salt hypertensive rats. Kidney International 24: 731–739, 1983

    Article  CAS  PubMed  Google Scholar 

  • Fujita T, Ando K. Hemodynamic and endocrine changes associated with potassium supplementation in sodium-loaded hypertensives. Hypertension 6: 184–192, 1984

    CAS  PubMed  Google Scholar 

  • Fujita T, Noda H, Ando K. Sodium susceptibility and potassium effects in young patients with borderline hypertension. Circulation 69: 468–476, 1984

    Article  CAS  PubMed  Google Scholar 

  • Gabriel R, Baylor P. Comparison of the chronic effects of bendrofluazide, bumetamide and frusemide on plasma biochemical variables. Postgraduate Medical Journal 57: 71–74, 1981

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Gennari FJ, Cohen JJ. Role of the kidney in potassium homeostasis. Lessons from acid base disturbances. Kidney International 8: 1–5, 1975

    CAS  PubMed  Google Scholar 

  • Gill JR, Frolich JC, Bowden RE, Taylor AA, Keiser RH, et al. Bartter’s syndrome. A disorder characterized by high urinary prostaglandins and a dependence of hyperreninemia on prostaglandin synthesis. American Journal of Medicine 61: 43–51, 1976

    Google Scholar 

  • Glynn IM. Sodium and potassium movements in human red cells. Journal of Physiology (London) 134: 278–310, 1956

    Article  CAS  Google Scholar 

  • Goodfellow A, Alaghband-Zadeh J, Carter G, Cream JJ, Holland S, et al. Oral sprionolactone improves acne vulgaris and reduces sebum excretion. British Journal of Dermatology 111: 209–214, 1984

    Article  CAS  PubMed  Google Scholar 

  • Griggs RC, Engel WK, Resnick JS. Acetazolamide treatment of hypokalemic periodic paralysis. Annals of Internal Medicine 73: 39–48, 1970

    Article  CAS  PubMed  Google Scholar 

  • Griggs RC, Resnick J, Engel MK. Intravenous treatment of hypokalemic periodic paralysis. Archives of Neurology 40: 539–540, 1983

    Article  CAS  PubMed  Google Scholar 

  • Grimm RH, Leon AS, Hunnigshake DB, Lenz K, Hannan P, et al. Effects of thiazide diuretics on plasma lipids and lipoproteins in mildly hypertensive patients. A double blind controlled trial. Annals of Internal Medicine 94: 7–11, 1981

    Article  PubMed  Google Scholar 

  • Grimm RH, Kofron PM, Neaton JD, Svendsen KH, Elmer PJ, et al. Effect of potassium supplementation combined with dietary sodium reduction on blood pressure in men taking antihypertensive medication. Journal of Hypertension 6 (Suppl. 4): S591–S593, 1988

    Article  CAS  PubMed  Google Scholar 

  • Grimm RH, Neaton JD, Elmer PJ, Svendsen KH, Levin J, et al. The influence of oral potassium chloride on blood pressure in hypertensive men on a low-sodium diet. New England Journal of Medicine 322: 569–574, 1990

    Article  PubMed  Google Scholar 

  • Grobbee DE, Hofman A, Roelandt JT, Boosma F, Schalekamp MA, et al. Sodium restriction and potassium supplementation in young people with mildly elevated blood pressure. Journal of Hypertension 5: 115–119, 1987

    Article  CAS  PubMed  Google Scholar 

  • Haenszel W, Kurihara M, Segi M, Lee RKC. Stomach cancer among Japanese in Hawaii. Journal of the National Cancer Institute 49: 969–988, 1972

    CAS  PubMed  Google Scholar 

  • Haenszel W, Correa P, Cuello C, Guzman N, Burbano LC, et al. Gastric cancer in Colombia. II. Case-control epidemiologic study of precursor lesions. Journal of the National Cancer Institute 57: 1021–1026, 1976

    Article  CAS  PubMed  Google Scholar 

  • Heath W, Freis E. Triamterene with hydrochlorothiazide in the treatment of hypertension. Journal of the American Medicine Association 186: 119–122, 1963

    Article  CAS  Google Scholar 

  • Herman TS, Fimognari GM, Edelman IS. Studies on renal aldosterone- binding proteins. Journal of Biological Chemistry 243: 3849–3856, 1986

    Google Scholar 

  • Holland OB, Nixon JV, Kuhnert L. Diuretic induced ventricular ectopic activity. American Journal of Medicine 70: 762–768, 1981

    Article  CAS  PubMed  Google Scholar 

  • Holland OB. Mild hypokalaemia in nonedematous, non-digitalised patients: The case for routinely normalizing serum potassium. In Nairns (Ed.) Controversies in Nephrology and Hypertension, pp. 345–358, Churchill Livingston, New York, 1984

    Google Scholar 

  • Holland OB, Kuhnert I, Pollard J, Padia M, Anderson RJ, et al. Ventricular ectopic activity with diuretic therapy. American Journal of Hypertension 1: 380–385, 1988

    Article  CAS  PubMed  Google Scholar 

  • Horisberger JD, Giebisch G. Potassium sparing diuretics Renal Physiology 10: 198–220, 1987

    CAS  PubMed  Google Scholar 

  • Hulter HN, Licht JH, Glynn RD, Sebastian A. Pathophysiology of chronic renal tubular acidosis induced by adminstration of amiloride. Journal of Laboratory and Clinical Medicine 95: 637–653, 1980

    CAS  PubMed  Google Scholar 

  • Hussain M, Walton K, Davidson C, Morgan DB. A study of two different diuretic/potassium combinations in heart failure. Postgraduate Medical Journal 61: 29–33, 1985

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Iimura O, Kijima T, Kikuchi K, Miyama A, Ando T, et al. Studies on the hypotensive effect of high potassium intake in patients with essential hypertension. Clinical Science 61 (Suppl.): 77s–80s, 1981

    Article  CAS  PubMed  Google Scholar 

  • Intersalt Co-operative Research Group. Intersalt: an international study of electrolyte and blood pressure. Results for 24 hour urinary sodium and potassium excretion. British Medical Journal 297: 319–328, 1988

    Article  Google Scholar 

  • ISIS-4 collaborative study. Fourth international study of infarct survival: protocol for a large simple study of effects of oral mononitrate, of oral captopril, and of intravenous magnesium. American Journal of Cardiology 68: 87D–100D, 1991

    Article  Google Scholar 

  • Jackson P, Ramsey L, Wakefield V. Relative potencey of spironolactone, triamterene and potassium chloride in thiazide-induced hypokalemia. British Journal Clinical Pharmacology 14: 257–263, 1982

    Article  CAS  Google Scholar 

  • Jain SC, Sing MV, Sharma VM, Rawal SB, Tyagi AK. Amelioration of acute mountain sickness: comparative study of acetazolamide and spironolactone. International Journal of Biometrology 30: 293–300, 1986

    Article  CAS  Google Scholar 

  • Jansson B. Dietary, total body and intracellular potassium-to-sodium ratios and their influence on cancer. Cancer Detection & Prevention 14: 563–565, 1990

    CAS  Google Scholar 

  • Johansson BW. Effect of beta blockade on ventricular fibrillation and ventricular tachycardia induced circulatory arrest, in acute myocardial infarction. American Journal of Cardiology 57: 34F–37F, 1986

    Article  CAS  PubMed  Google Scholar 

  • Johnston GD, Wilson R, McDermott BJ, McVeigh GE, Duffin D, et al. Low dose cyclopenthiazide in the treatment of hypertension: a one year community based study. Quarterly Journal of Medicine 289: 135–143, 1991

    Google Scholar 

  • Judge TG, Cowan NR. Dietary potassium intake and grip strength in older people. Gerontologia Clinica 13: 221–224, 1971

    Article  CAS  PubMed  Google Scholar 

  • Kagana CM, Sturtevant FM, Van Annan CG. Pharmacology of a new steroid that blocks salt activity of aldosterone and deoxycorticosterone. Journal of Pharmacology and Experimental Therapeutics 126: 123–130, 1959

    Google Scholar 

  • Kaplan NM. The clinical use of diuretics in the treatment of hypertension. Clinical and Experimental Hypertension A5: 167–176, 1983

    Google Scholar 

  • Kaplan NM. Our appropriate concern about hypokalaemia. American Journal of Medicine 70: 762–768, 1984

    Google Scholar 

  • Kaplan NM, Carnegie A, Raskin P, Heller JA, Simmons M. Potassium supplementation in hypertensive patients with diuretic-induced hypokalemia. New England Journal of Medicine 312: 746–749, 1985

    Article  CAS  PubMed  Google Scholar 

  • Karim A. Spironolactone metabolism in man revisted. In Brunner (Ed.) Contemporary trends in diuretic therapy, pp. 23–27, Excerpta Medica, Amsterdam, 1986

    Google Scholar 

  • Kassier JP, Harrington JT. Diuretics and potassium metabolism: a reassessment of the need, effectivness and safety of potassium therapy. Kidney International 11: 505–515, 1977

    Article  Google Scholar 

  • Keim H, Drayer J, Thurston H, Laragh J. Triamterene induced changes in aldosterone and renin values in essential hypertension. Archives of Internal Medicine 136: 645–648, 1976

    Article  CAS  PubMed  Google Scholar 

  • Khaw KT, Thorn S. Randomised double-blind cross-over trial of potassium on blood pressure in normal subjects. Lancet 2: 1127–1129, 1982

    Article  CAS  PubMed  Google Scholar 

  • Khaw KT, Barrett-Connor E. Dietary potassium and blood pressure in a population. American Journal of Clinical Nutrition 39: 963–968, 1984

    CAS  PubMed  Google Scholar 

  • Khaw KT, Barrett-Connor E. Dietary potassium and stroke-associated mortality. A 12-year prospective population study. New England Journal of Medicine 316: 235–240, 1987

    Article  CAS  PubMed  Google Scholar 

  • Kirchner KA, Kotchen TA, Galla JA, Luke RG. Importance of chloride for the acute inhibition of renin by sodium chloride. American Journal of Physiology 235: F444–F450, 1978

    CAS  PubMed  Google Scholar 

  • Kleber FX, Niemoller L, Doering W. Impact of converting enzyme inhibition on progression of chronic heart failure: results of the Munich Mild Heart Failure Trial. British Heart Journal 67: 289–296, 1992

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Knauf H, Mohrke W, Mutschier E. Delayed elimination of triamterene and its active metabolite in chronic renal failure. European Journal Clinical Pharmacology 24: 453–456, 1983

    Article  CAS  Google Scholar 

  • Kohvakka A. Maintainance of potassium balance during long-term diuretic therapy in chronic heart failure patients with thiazide induced hypokalaemia: comparison of potassium supplementation with potassium chloride and potassium sparing agents, amiloride and triamterine. International Journal of Clinical Pharmacology, Therapy and Toxicology 26: 273–277, 1988

    CAS  Google Scholar 

  • Krishna GG, Miller E, Kapoor S. Increased blood pressure during potassium depletion in normotensive men. New England Journal of Medicine 320: 1177–1182, 1989

    Article  CAS  PubMed  Google Scholar 

  • Kromhout D, Bosschieter EB, Coulander CdeL. Potassium, calcium, alcohol intake and blood pressure: the Zutphen Study. American Journal of Clinical Nutrition 41: 1299–1304, 1985

    CAS  PubMed  Google Scholar 

  • Langford HG. Dietary potassium and hypertension: epidemiologic data. Annals of Internal Medicine 98: 770–772, 1983

    Article  CAS  PubMed  Google Scholar 

  • Lant A. Diuretics: clinical pharmacology and therapeutic use. Drugs 29: 162–188, 1985

    Article  CAS  PubMed  Google Scholar 

  • Laragh J, Reilly E, Stites T, Angers M. Prendine compound as an inhibitor of aldosterone action in man. Abstract. Federal Proceedings 20: 410, 1961

    Google Scholar 

  • Lawrason FD, Alpert E, Mohr FL, McMahon FG. Ulcerative-obstructive lesions of the small intestine. Journal of the American Medical Association 191: 641–643, 1965

    Article  CAS  PubMed  Google Scholar 

  • Lawson DH. The clinical use of potassium supplements. Journal of the Maine Medical Association 66: 166–169, 1975

    CAS  PubMed  Google Scholar 

  • Leary WP, Reyes AJ, Van der Byl K, Effect of a combination of hydrochlorothiazi de and amilori de on urinary magnesium excretion in healthy adults. Abstract. Current Therapeutic Research 35: 293, 1984

    CAS  Google Scholar 

  • Lemann J, Pleuss JA, Gray RW, Hoffmann RG. Potassium administration increases and potassium deprivation reduces urinary calcium excretion in healthy adults. Kidney International 39: 973–983, 1991

    Article  PubMed  Google Scholar 

  • Levene DL. Potassium chloride: absorption and excretion. Canadian Medical Association Journal 108: 853–855, 1973

    CAS  PubMed  PubMed Central  Google Scholar 

  • Liddle GN. Specific and nonspecific inhibition of mineralocorticoid activity. Metabolism 10: 1021–1030, 1961

    CAS  Google Scholar 

  • Liddle GN. Aldosterone antagonists and triamterine. Annals of the New York Academy of Sciences 139: 466–470, 1966

    Article  CAS  PubMed  Google Scholar 

  • Lim P, Jacob E. Magnesium deficiency in patients on long-term diuretic therapy for heart failure. British Medical Journal 3: 620–622, 1972

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • MacGregor GA, Smith SJ, Markandu ND, Banks RA, Sagnella GA. Moderate potassium supplementation in essential hypertension. Lancet 2: 567–570, 1982

    Article  CAS  PubMed  Google Scholar 

  • MacGregor GA, Banks RA, Markandu ND, Bayliss J, Roulston J. Lack of effect of beta blocker on flat response to thiazide in hypertension: efficacy of low dose thiazide combined with beta blocker. British Medical Journal 286: 1535–1538, 1983

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • MacGregor GA. Dietary sodium and potassium intake and blood pressure. Lancet 1: 750–753, 1983

    Article  CAS  PubMed  Google Scholar 

  • Mahensmith R, Their SO, Cooke CR, Broadus A, DeFronzo RA. Effect of acute metabolic acidemia on renal electrolyte trnsport in man. Metabolism 28: S31, 1979

    Google Scholar 

  • Matlou SM, Isles CG, Higgs A, Milne FJ, Murray GD, et al. Potassium supplementation in blacks with mild to moderate essential hypertension. Journal of Hypertension 4: 61–64, 1986

    Article  CAS  PubMed  Google Scholar 

  • McCaughan D. Hazards of non-prescription potassium supplements. Correspondence. Lancet 1: 543, 1984

    Google Scholar 

  • McVeigh G, Galloway D, Johnston D. The case for low dose diuretics in hypertension: comparison of low and conventional doses of cyclopenthiazide. British Medical Journal 297: 95–98, 1988

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Medical Research Council Working Party on mild to moderate hypertension. Ventricular exrasytoles during thiazide treatment: substudy of MRC mild hypertension trial. British Medical Journal 287: 1249–1253, 1983

    Article  Google Scholar 

  • Medical Research Council Working Party. Medical Research Council trial of treatment of mild hypertension: principal results. British Medical Journal 291: 97–104, 1985

    Article  Google Scholar 

  • Medical Research Council Working Party. Medical Research Council trial of treatment of hypertension in older adults: principal results. British Medical Journal 304: 405–413, 1992

    Article  Google Scholar 

  • Michelakis AM, Yoshida H, Dormois JC. Plasma renin activity and plasma aldosterone during the normal menstrual cycle. American Journal of Obstetrics and Gynecology 123: 724–726, 1975

    Article  CAS  PubMed  Google Scholar 

  • Miller SM, Weinberger MH, Christian JC. Blood pressure response to potassium supplementation in normotensive adults and children. Hypertension 10: 437–442, 1987

    Article  CAS  PubMed  Google Scholar 

  • Millson D, Borland C, Murphy P, Davison W. Hyponatraemia and ‘Moduretic’. British Medical Journal 289: 1308–1309, 1984

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Mirvish SS. Blocking the formation of N-nitroso compounds with ascorbic acid in vivo and in vitro. Annals of the New York Academy of Sciences 250: 175–180, 1975

    Article  Google Scholar 

  • Morgan DB, Davidson C. Hypokalemia and diuretics: an analysis of publications. British Medical Journal 280: 950–908, 1980

    Google Scholar 

  • Morin Y, Turmel L, Fortier J. Triamterene: clinical studies in arterial hypertension. American Heart Journal 69: 195–199, 1965

    Article  CAS  PubMed  Google Scholar 

  • Multiple Risk Factor Intervention Trial Research Group (MRFIT). Journal of American Medical Association 248: 1465–1477, 1982

    Article  Google Scholar 

  • Munday MR, Brush MG, Taylor RW. Correlations between progesterone estradiol and aldosterone levels in the premenstrual syndrome. Clinical Endocrinology 14: 1–9, 1981

    Article  CAS  PubMed  Google Scholar 

  • Mutschler E, Gilfrich H, Knauf H, Mohrke W, Volger K. Pharmacokinetics of triamterene. Clinical Experimental Hypertension 5: 249–269, 1983a

    CAS  PubMed  Google Scholar 

  • Mutschler E, Gilfrich H, Mohrke W, Volger K. Pharmokinetics of triamterene in healthy volunteers and patients with liver and kidney disease. Klinische Wochenschrift 61: 883–891, 1983b

    Article  CAS  PubMed  Google Scholar 

  • Myers MG. Hydrochlorothiazide with or without amiloride for hypertension in the elderly. A dose-tritation study. Archives of Internal Medicine 147: 1026–1030, 1987

    Article  CAS  PubMed  Google Scholar 

  • Obel AO. Placebo-controlled trial of potassium supplements in black patients with mild essential hypertension. Journal of Cardiovascular Pharmacology 14: 294–296, 1989

    Article  CAS  PubMed  Google Scholar 

  • Ober KP, Hennessey JF. Spironolactone therapy for hirsutism in a hyperandrogenic woman. Annals of Internal Medicine 89: 643–644, 1978

    Article  CAS  PubMed  Google Scholar 

  • O’Brien PMS, Craven D, Selby C, Symonds EM. Treatment of premenstrual syndrome by spironolactone. British Journal of Obstetrics and Gynaecology 86: 142–147, 1979

    Article  PubMed  Google Scholar 

  • Ochs HR, Greenblatt DJ, Bodem G, Smith TW. Spironolactone. American Heart Journal 96: 389–400, 1978

    Article  CAS  PubMed  Google Scholar 

  • O’Driscoll J, Anderson DC. Hirsutism. Correspondence. British Medical Journal 301: 1215, 1990

    Article  Google Scholar 

  • Olsen ME, Jensen HE. Amiloride treatment in patients with potassium-losing nephropathy. Danish Medical Bulletin 28: 210–212, 1981

    CAS  PubMed  Google Scholar 

  • Os I, Kjeldsen SE, Westheim A, Jackson MB, Akesson I, et al. The effect of sodium depletion and potassium supplementation on vasopressin, renin and catecholamines in hypertensive men. Acta Medica Scandinavica 220: 195–203, 1986

    Article  CAS  PubMed  Google Scholar 

  • Oseas RS, Phelps DL, Kaplan SA. Near fatal hyperkalaemia from a dangerous treatment for colic. Pediatrics 69: 117–118, 1982

    CAS  PubMed  Google Scholar 

  • Othieno A, Koech DK. Potassium supplementation versus bendrofluazide in mildly to moderately hypertensive Kenyans. Journal of Cardiovascular Pharmacology 17: 504–507, 1991

    Article  Google Scholar 

  • Overlack A, Muller HM, Kolloch R, Ollig A, Moch B, et al. Long-term antihypertensive effect of oral potassium in essential hypertension. Journal of Hypertension 1 (Suppl. 2): 165–167, 1983

    Google Scholar 

  • Papademetriou V, Burris J, Kukich S, Fries E. Effectiveness of potassium chloride or triamterene in thiazide hypokalemia. Archives of Internal Medicine 145: 1986–1990, 1985

    Article  CAS  PubMed  Google Scholar 

  • Papademetriou V. Diuretics, Hypokalaemia and cardiac arrhythmias, a critical analysis. American Heart Journal 111: 1217–1224, 1986

    Article  CAS  PubMed  Google Scholar 

  • Perez GO, Oster JR, Pelleya R, Caralis PV, Kern DC. Hyperkalaemia from a single small oral dose of potassium chloride. Nephron 36: 270–271, 1984

    Article  CAS  PubMed  Google Scholar 

  • Perez-Ayuso RM, Arroyo V, Planas R, Gaya J, Bory F, et al. Randomised comparative study of efficacy of furosemide versus spironolactone in non-azotemic cirrhosis with ascites. Relationship between the diuretic response and the activation of the renin angiotensin aldosterone system. Gastroenterology 84: 961–968, 1983

    CAS  Google Scholar 

  • Pfeffer MA, Braunwald E, Moye LA, Basta L, Brown EJ, et al. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction — results of the survival and ventricular enlargement trial. New England Journal of Medicine 327: 669–677, 1992

    Article  CAS  PubMed  Google Scholar 

  • Ponce SP, Jennings AE, Madias NE, Harrington JT. Drug induced hyperkalaemia. Medicine 64: 357–370, 1985

    Article  CAS  PubMed  Google Scholar 

  • Poole-Wilson PA. Hypokalaemia induced by thiazide diuretics in the treatment of hypertension: cause for concern not nihilism. Postgraduate Medical Journal 59 (Suppl. 3): 137–139, 1983

    PubMed  Google Scholar 

  • Poole-Wilson PA, Lindsay D. Advances in the treatment of chronic heart failure. British Medical Journal 304: 1069–1070, 1992

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Pruitt A, Winkel J, Dayton P. Variations in the fate of triamterene. Clinical Pharmacology and Therapeutics 21: 610–619, 1977

    Article  CAS  PubMed  Google Scholar 

  • Ramsey LE, Boyle A, Ramsay MH. Factors influencing serum potassium in treated hypertension. Quarterly Journal of Medicine 46: 401–410, 1977

    Google Scholar 

  • Ramsey LE, McInnes GT, Hettiarachi J, Shelton J, Scott P. Bumetamide and frusemide. A comparison of dose-response curves in healthy men. British Journal of Clinical Pharmacology 5: 243–247, 1978

    Google Scholar 

  • Ramsey LE. Does K+ loss with diuretics matter? MIMS Magazine 13: 39–44, Aug, 1989

    Google Scholar 

  • Rasmussen HS, McNair P, Norregard P, Backer V, Lindenberg O, et al. Intravenous magnesium in acute myocardial infarction. Lancet 1: 234–236, 1986

    Article  CAS  PubMed  Google Scholar 

  • Reed D, McGee D, Yano K, Hankin J. Diet, blood pressure, and multicollinearity. Hypertension 7: 405–410, 1985

    CAS  PubMed  Google Scholar 

  • Richards AM, Nicholls MG, Espiner EA, Ikram H, Maslowski AH, et al. Blood pressure response to moderate sodium restriction and to potassium supplementation in mild essential hypertension. Lancet 1: 757–761, 1984

    Article  CAS  PubMed  Google Scholar 

  • Riggs JE, Griggs RC. Diagnosis and treatment of the periodic paralyses. Clinical Neuropharmacology 4: 123–138, 1979

    Article  Google Scholar 

  • Risler T, Kramer B, Muller GA. The efficacy of diuretics in acute and chronic renal failure. Drugs 41 (Suppl. 3): 69–79, 1991

    Article  PubMed  Google Scholar 

  • Rook A, Dawber RPR. In Diseases of hair and scalp, pp. 95–98, Blackwell Scientific Publications, Oxford, 1982

    Google Scholar 

  • Rosenthal T, Adar R, Militianu J, Deutsch V. Esophageal ulceration and oral potassium chloride ingestion. Chest 65: 463–465, 1974

    Article  CAS  PubMed  Google Scholar 

  • Rushton DH, Futterwit W, Kingsley DH, Kingley P, Norris MJ. Quantitative assesment of spironolactone treatment in women with diffuse androgen-dependent alopecia. Journal of the Society of Cosmetic Chemistry 42: 317–325, 1991

    Google Scholar 

  • Sandor FF, Pickens PT, Crallan J. Variations of plasma potassium concentrations during long-term treatment of hypertension with diuretics without potassium supplements. British Medical Journal 284: 711–715, 1982

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Sarin SK, Sachdev G, Mishra SP, Sundaram KR, Shrivastwa A, et al Bumetamide, spironolactone and a combination of the two in the treatment of ascites due to liver disease: a prospective, controlled, randomised trial. Digestion 41: 101–107, 1988

    Article  CAS  PubMed  Google Scholar 

  • Schwartz AB, Swartz C. Dosage of potassium chloride elixir to correct thiazide induced hypokalemia. Journal of the American Medical Association 230: 702–704, 1974

    Article  CAS  PubMed  Google Scholar 

  • Schwartz WB. Potassium and the kidney. New England Journal of Medicine 253: 601–604, 1955

    Article  CAS  PubMed  Google Scholar 

  • Shah V, Walker M, Prasad VC, Lin J, Knapp G, et al. Preliminary observations on dissolution and bioavailability of triamterene hyrocholorothiazide combination products. Biopharmaceutics and Drug Disposition 5: 11–19, 1984

    Article  CAS  PubMed  Google Scholar 

  • Shaw JC. Spironolactone in dermatologic therapy. Journal of the American Academy of Dermatology 24: 236–243, 1991

    Article  CAS  PubMed  Google Scholar 

  • SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Journal of the American Medical Association 265, 3255–3264, 1991

    Article  Google Scholar 

  • Siani A, Strazzullo P, Russo L, Guglielmi S, Iacoriello L, et al. Controlled trial of long term oral potassium supplements in patients with mild hypertension. British Medical Journal 294: 1453–1456, 1987

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Siani A, Strazzullo P, Giacco A, Pacioni D, Celentano E, et al. Increasing the dietary potassium intake reduces the need for anti-hypertensive medication. Annals of Internal Medicine 115: 753–759, 1991

    Article  CAS  PubMed  Google Scholar 

  • Sica DA, Gehr TWB. Triamterene and the kidney. Nephron 51: 454–461, 1989

    Article  CAS  PubMed  Google Scholar 

  • Skrabal F, Aubock J, Hortnagl H. Low sodium/high potassium diet for prevention of hypertension: probable mechanism of action. Lancet 2: 895–900, 1981

    Article  CAS  PubMed  Google Scholar 

  • Smith SJ, Markandu ND, Sagnella GA, Poston L, Hilton PJ, et al. Does potassium lower blood pressure by increasing sodium excretion? A metabolic study in patients with mild to moderate essential hypertension. Journal of Hypertension 1 (Suppl. 2): 27–30, 1983

    CAS  PubMed  Google Scholar 

  • Smith SJ, Markandu ND, Sagnella GA, MacGregor GA. Moderate potassium chloride supplementation in essential hypertension: is it additive to moderate sodium restriction? British Medical Journal 290: 110–113, 1985

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Smith WO, Kypriakopoulos A, Mock DC, Hammersten GF. The influence of various diuretic agents on the urinary excretion of magnesium in non-edematous subjects. Abstract. Clincal Research 7: 162, 1959

    Google Scholar 

  • SOLVD Investigators. Effects of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive cardiac failure. New England Journal of Medicine 325: 293–302, 1992

    Google Scholar 

  • Sopko JA, Freeman RM. Salt substitutes as a source of potassium. Journal of the American Medical Association 238: 608–610, 1977

    Article  CAS  PubMed  Google Scholar 

  • Stewart DE, Ikram H, Espiner EA, Nicholls MG. Arrhythmogenic potential of diuretic induced hypokalemia in patients with mild hypertension and ischaemic heart disease. British Heart Journal 54: 290–297, 1985

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Stier CT, Itskovitz HD. Renal calcium metabolism. Annual Review of Pharmacology and Toxicology 26: 101–116, 1986

    Article  PubMed  Google Scholar 

  • Svetkcy LP, Yarger WE, Feussner JR, DeLong E, Klotman PE. Double-blind, placebo-controlled trial of potassium chloride in the treatment of mild hypertension. Hypertension 9: 444–450, 1987

    Article  Google Scholar 

  • Tannen RL. Influence of potassium on blood pressure. Kidney International 32 (Suppl. 22): 242–248, 1987

    Google Scholar 

  • Teo KT, Yusuf S. Role of magnesium in reducing mortality in acute myocardial infarction: a review of the evidence. Drugs 46: 347–359, 1993

    Article  PubMed  Google Scholar 

  • Teo KT, Yusuf S, Collins R, Held PH, Peto R. Effects of intravenous magnesium in suspected acute myocardial infarction: overview of randominsed trials. British Medical Journal 303: 1499–1503, 1991

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Tobian L, Lange J, Ulm K, Wold L, Iwai J. Potassium reduces cerebral hemorrhage and death rate in hypertensive rats, even when blood pressure is not lowered. Hypertension 7 (Suppl. I): 1110–1114, 1985

    Google Scholar 

  • Toner JM, Ramsey LE. Thiazide induced hypokalaemia; prevelance higher in women. British Journal of Clinical Pharmacology 18: 449–452, 1984

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Vannan MA, Taylor DJE, Webb-Peploe MM, Konstam MA. ACE inhibitors after myocardial infartion. British Medical Journal 306: 531–532, 1993

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Velazquez H, Wright FS. Control by drugs of renal potassium handling. Annual Review of Pharmacology and Toxicology 26: 293–309, 1986

    Article  CAS  PubMed  Google Scholar 

  • Verberckmoes R, Van Damme B Clement J, Armery A, Michielsen P. Bartter’s syndrome with hyperlasia of renomedullary cells. Successful treatment with indomethacin. Kidney International 9: 302–307, 1976

    Article  CAS  PubMed  Google Scholar 

  • Volpe M, Camargo MJF, Mueller FB, Campbell WG, Sealey JE, et al. Elation of plasma renin to end organ damage and to protection of K feeding in stroke-prone hypertensive rats. Hypertension 15: 318–326, 1990

    Article  CAS  PubMed  Google Scholar 

  • Wagner BM. Long-term toxicology studies of spironolactone in animals and comparison of potassium canrenoate. Journal of Drug Development 1 (Suppl. 2): 7–11, 1987

    Google Scholar 

  • Webb S, Schade DS. Hypomagnesaemia as a cause of persistent hypokalaemia. Journal of the American Medical Association 233: 23–24, 1971

    Article  Google Scholar 

  • Weiner IM. Diuretics and other agents employed in the mobilization of edema fluid. In Gilman et al. (Eds) Goodman & Gilman’s The pharmacological basis of therapeutics, 8th ed., pp. 713–731, Pergamon Press, New York, 1990

    Google Scholar 

  • Weisburger JD. Mechanism of diet as a carcinogen. Cancer 43: 1987–1995, 1979

    Article  CAS  PubMed  Google Scholar 

  • Weissberg PL, West MJ, Kendall MJ, Ingram M, Woods KL. Effect of changes in dietary sodium and potassium on blood pressure and cellular electrolyte handling in young normotensive subjects. Journal of Hypertension 3: 475–480, 1985

    CAS  PubMed  Google Scholar 

  • Wetli CV, Davis JH. Fatal hyperkalaemia from accidental overdose of potassium chloride. Correspondence. Journal of the American Medical Association 240: 1339, 1978

    Article  CAS  PubMed  Google Scholar 

  • Whelton PK, Brennan P, Miall WE, Greenberg G, Subramanian B, et al. Thiazide associated cardiac arrhythmias. Abstract. Circulation 66: (Suppl. 2): 238, 1982

    Google Scholar 

  • Williams R, Thornhill M, Upton R, Blume C, Clark T, et al. Absorption and disposition of two combination forumulations of hydrochlorothiazide and triamterene: influence of age and renal function. Clinical Pharmacology and Therapeutics 40: 226–232, 1986

    Article  CAS  PubMed  Google Scholar 

  • Wynder EL, Kmet J, Dungal N, Segi M. An epidemiological investigation of gastric cancer. Cancer 16: 1461–1496, 1963

    Article  CAS  PubMed  Google Scholar 

  • Wynn V, Harper P, Freire A. Bioavailability of potassium from Burinex K. Journal of International Medical Research 2: 314–316, 1974

    Article  Google Scholar 

  • Ylostalo P, Heikkinen J, Kanappila A, Pakarinen A, Jarvinen PA. Low dose spironolactone in the treatment of female hirsutism. International Journal of Fertility 32: 41–45, 1987

    CAS  PubMed  Google Scholar 

  • Zoccali C, Cumming AMM, Hutcheson MJ, Barnett P, Semple PF. Effects of potassium on sodium balance, renin, noradrenaline and arterial pressure. Journal of Hypertension 3: 67–72, 1985

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Blood Pressure Unit, Department of Medicine, St George’s Hospital Medical School, Cranmer Terrace, London, SW17 0RE, England

    Anand K. Saggar-Malik &  Francesco P. Cappuccio

Authors
  1. Anand K. Saggar-Malik
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francesco P. Cappuccio
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

An erratum to this article is available at http://dx.doi.org/10.1007/BF03259116.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Saggar-Malik, A.K., Cappuccio, F.P. Potassium Supplements and Potassium-Sparing Diuretics. Drugs 46, 986–1008 (1993). https://doi.org/10.2165/00003495-199346060-00005

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00003495-199346060-00005

Keywords

Search

Navigation