Does Triamterene Enhance Hydrochlorothiazide's Hypotensive Effect?

Summary and Comment |
January 14, 2016

Does Triamterene Enhance Hydrochlorothiazide's Hypotensive Effect?

  1. Allan S. Brett, MD

In an observational study, combination therapy was associated with slightly lower blood pressure than was HCTZ monotherapy.

  1. Allan S. Brett, MD

To mitigate the hypokalemic effects of hydrochlorothiazide (HCTZ), the drug is available in combination with the potassium-sparing diuretic triamterene (combination products are Dyazide, Maxzide, and generics). However, whether triamterene also enhances HCTZ's hypotensive effect is unclear. Researchers addressed this question in an observational analysis of electronic records serving a healthcare network in metropolitan Indianapolis. About 3000 HCTZ recipients who also received triamterene were compared with about 14,000 HCTZ recipients who did not; propensity-score analysis was performed to adjust for background differences in the two groups.

When HCTZ was used without other blood pressure (BP)–lowering drugs, mean BP was significantly lower with HCTZ/triamterene than with HCTZ alone (by 4 mm Hg systolic and 1 mm Hg diastolic). When HCTZ was used with other drug classes (e.g., angiotensin-converting–enzyme inhibitors, calcium-channel blockers, β-blockers), addition of triamterene was associated with smaller — albeit still statistically significant — mean differences in systolic BP (2–3 mm Hg lower).


When HCTZ-treated patients develop hypokalemia, combining HCTZ with triamterene is a reasonable alternative to prescribing supplemental potassium. This analysis suggests that triamterene might also lower BP modestly when added to HCTZ. The study's limitation, of course, is its retrospective observational nature.

Editor Disclosures at Time of Publication

  • Disclosures for Allan S. Brett, MD at time of publication Nothing to disclose


Reader Comments (2)

DALE TERRELL Physician, Geriatrics, UAMS-SC

For women, at least, it would seem more logical to add spironolactone to HCTZ with the expectation of better anti-hypertensive effect (and other benefits on remodeling, etc.) and perhaps using triamterene in men.1533

e gaertner,MD Physician, Internal Medicine

how and where does chlorthalidone fit into the picture of BP control

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