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Antihypertensive Therapy With Triamterene-Hydrochlorothiazide vs Amiloride-Hydrochlorothiazide: Comparison of Effects on Urinary Prostaglandin E2 Excretion

Antihypertensive Therapy With Triamterene-Hydrochlorothiazide vs Amiloride-Hydrochlorothiazide:... Abstract • Amiloride hydrochloride has now been recognized as a safe and effective potassium-sparing diuretic alternative to triamterene with a similar mechanism of pharmacologic activity. Studies were undertaken to assess the difference between therapy with the triamterene-hydrochlorothiazide combination (Dyazide) and an amiloride hydrochloride-hydrochlorothiazide combination (Moduretic) on renal prostaglandin production, since an increase in renal prostaglandin synthesis has been shown to mediate or enhance the pharmacologic action of certain diuretic drugs. Eight subjects treated for four weeks with triamterene-hydrochlorothiazide were compared with nine patients similarly treated with amiloride-hydrochlorothiazide. A 24-hour urine sample for prostaglandin E2 (PG E2) assay was collected under control conditions and after six weeks of therapy with either diuretic in all patients. The PGE2 excretion increased in the amiloride-hydrochlorothiazide-treated group; in the other group PGE2 excretion actually declined. It is concluded from these studies that therapy with amiloride-hydrochlorothiazide enhanced renal PGE2 production, whereas that with triamterene-hydrochlorothiazide actually decreased renal PGE2 production. This difference Is an important renal consequence of the use of either drug and should be considered In the choice between these diuretic combinations. (Arch Intern Med 1986;146:1312-1314) References 1. Kramer HJ, Dusing R, Stinnesbech B, et al: Interaction of conventional and antikaliuretic diuretics with the renal prostaglandin system. Clin Sci 1980;59:67-70. 2. Tannenbaum J, Splowinski JA, Oates JA, et al: Enhanced renal prostaglandin production in the dog: I. Effects on renal function. Circ Res 1975;36:197-203.Crossref 3. Grantham JJ, Oreoff J: Effect of prostaglandin E2 on the permeability response of the isolated collecting tubule to vasopressin, adenoside 3′, 5′-monophosphate, and theophylline. J Clin Invest 1968;47:1154-1161.Crossref 4. Vatner SF: Effects of hemorrhage on regional blood flow distribution in dogs and primates. J Clin Invest 1974;54:225-235.Crossref 5. Zawada ET Jr: The adaptive role of renal prostaglandin production: Current clinical problems and future clinical horizons. Nephron 1984;36:77-79.Crossref 6. Frolich JC, Wilson TW, Sweetman BJ, et al: Urinary prostaglandins. J Clin Invest 1975;55:763-770.Crossref 7. Zawada ET, Dornfeld LD, Tuck M, et al: Defective renal prostaglandin synthesis in patients with morbid obesity. Nephron 1985;39:361-364.Crossref 8. Papanicolau N, Lefkos N, Massourides E, et al: Interaction between aldosterone and renomedullary prostaglandins competitive action between aspirin and spironolactone. Experientia 1978;33:1633-1635. 9. Zawada ET, Bennett EB, Johnson M: Quantitation of the antagonism of diuretics by indomethacin. Circulation 1980;62:90. 10. Tweeddale MG, Ogilvie RI: Antagonism of spironolactone-induced natriuresis by aspirin in man. N Engl J Med 1973;289:198-200.Crossref 11. Chiba S, Abe K, Yasujima M, et al: Effect of triamterene on urinary excretion of immunoreactive prostaglandin E in essential hypertension. Tohoku J Exp Med 1979;129:249-256.Crossref 12. Favre L, Glasson PH, Riondel A, et al: Interaction of diuretics and nonsteroidal anti-inflammatory drugs in man. Clin Sci 1983;64:407-415. 13. Zawada ET Jr: The role of prostaglandins and calcium in hypertension. Nephron 1982;32:97-101.Crossref 14. Spence JD, Wong DG, Lindsay RM: Effects of triamterene and amiloride on urinary sediment in hypertensive patients taking hydrochlorothiazide. Lancet 1985;2:73-74.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Antihypertensive Therapy With Triamterene-Hydrochlorothiazide vs Amiloride-Hydrochlorothiazide: Comparison of Effects on Urinary Prostaglandin E2 Excretion

Archives of Internal Medicine , Volume 146 (7) – Jul 1, 1986

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References (18)

Publisher
American Medical Association
Copyright
Copyright © 1986 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1986.00360190076010
Publisher site
See Article on Publisher Site

Abstract

Abstract • Amiloride hydrochloride has now been recognized as a safe and effective potassium-sparing diuretic alternative to triamterene with a similar mechanism of pharmacologic activity. Studies were undertaken to assess the difference between therapy with the triamterene-hydrochlorothiazide combination (Dyazide) and an amiloride hydrochloride-hydrochlorothiazide combination (Moduretic) on renal prostaglandin production, since an increase in renal prostaglandin synthesis has been shown to mediate or enhance the pharmacologic action of certain diuretic drugs. Eight subjects treated for four weeks with triamterene-hydrochlorothiazide were compared with nine patients similarly treated with amiloride-hydrochlorothiazide. A 24-hour urine sample for prostaglandin E2 (PG E2) assay was collected under control conditions and after six weeks of therapy with either diuretic in all patients. The PGE2 excretion increased in the amiloride-hydrochlorothiazide-treated group; in the other group PGE2 excretion actually declined. It is concluded from these studies that therapy with amiloride-hydrochlorothiazide enhanced renal PGE2 production, whereas that with triamterene-hydrochlorothiazide actually decreased renal PGE2 production. This difference Is an important renal consequence of the use of either drug and should be considered In the choice between these diuretic combinations. (Arch Intern Med 1986;146:1312-1314) References 1. Kramer HJ, Dusing R, Stinnesbech B, et al: Interaction of conventional and antikaliuretic diuretics with the renal prostaglandin system. Clin Sci 1980;59:67-70. 2. Tannenbaum J, Splowinski JA, Oates JA, et al: Enhanced renal prostaglandin production in the dog: I. Effects on renal function. Circ Res 1975;36:197-203.Crossref 3. Grantham JJ, Oreoff J: Effect of prostaglandin E2 on the permeability response of the isolated collecting tubule to vasopressin, adenoside 3′, 5′-monophosphate, and theophylline. J Clin Invest 1968;47:1154-1161.Crossref 4. Vatner SF: Effects of hemorrhage on regional blood flow distribution in dogs and primates. J Clin Invest 1974;54:225-235.Crossref 5. Zawada ET Jr: The adaptive role of renal prostaglandin production: Current clinical problems and future clinical horizons. Nephron 1984;36:77-79.Crossref 6. Frolich JC, Wilson TW, Sweetman BJ, et al: Urinary prostaglandins. J Clin Invest 1975;55:763-770.Crossref 7. Zawada ET, Dornfeld LD, Tuck M, et al: Defective renal prostaglandin synthesis in patients with morbid obesity. Nephron 1985;39:361-364.Crossref 8. Papanicolau N, Lefkos N, Massourides E, et al: Interaction between aldosterone and renomedullary prostaglandins competitive action between aspirin and spironolactone. Experientia 1978;33:1633-1635. 9. Zawada ET, Bennett EB, Johnson M: Quantitation of the antagonism of diuretics by indomethacin. Circulation 1980;62:90. 10. Tweeddale MG, Ogilvie RI: Antagonism of spironolactone-induced natriuresis by aspirin in man. N Engl J Med 1973;289:198-200.Crossref 11. Chiba S, Abe K, Yasujima M, et al: Effect of triamterene on urinary excretion of immunoreactive prostaglandin E in essential hypertension. Tohoku J Exp Med 1979;129:249-256.Crossref 12. Favre L, Glasson PH, Riondel A, et al: Interaction of diuretics and nonsteroidal anti-inflammatory drugs in man. Clin Sci 1983;64:407-415. 13. Zawada ET Jr: The role of prostaglandins and calcium in hypertension. Nephron 1982;32:97-101.Crossref 14. Spence JD, Wong DG, Lindsay RM: Effects of triamterene and amiloride on urinary sediment in hypertensive patients taking hydrochlorothiazide. Lancet 1985;2:73-74.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jul 1, 1986

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