Aims: To assess changes in electrolyte profiles in hypertensive Nigerians receiving dual medication with amlodipine (AML) and hydrochlorothiazide (HCZ).
Introduction: Hypertension is the most frequent noncommunicable disease in Nigeria, and it is the leading cause of hospitalisation and mortality among the indigenous people.
Trial Design: This was a 48-week randomised, open-label, prospective, two-center, outpatient study.
Methodology: We recruited 90 Nigerian men and women between the ages of 31 and 86 who had uncomplicated essential hypertension (blood pressure [BP] > 160/90 180/120mmHg). Patients in the AML, HCZ, and AML-HCZ groups received 5mg AML for 6 weeks (wks) and then 10mg until wk 12 (monotherapy) after which HCZ 25mg was added; HCZ 25mg until wk 6 (monotherapy) after which AML 5-10mg was added; and AML 5-10mg + HCZ 25mg. Body mass index (BMI), blood pressure (BP), 24-hour urine volume, and serum and urine electrolytes (Na+, K+, Cl-) were measured at the start of treatment and at the end of weeks 1, 3, 6, 12, 24, 36, and 48.
The three regimens all decreased blood pressure significantly (P=.05). In the HCZ group, diuresis was the highest and most significant (P=.05). Except for the AML M subgroup, all subgroups showed substantial (P.0001) hyponatraemic changes throughout time, with mean maximum M/F decreases of 5.07/14.74, 17.40/16.40, and 10.93/16.86 mmol/L in the AML, HCZ, and AML-HCZ groups, respectively. In all groups, a substantial (P.01) rise in urine Na+ was found, with the maximal mean M/F increases in the AML, HCZ, and AML-HCZ groups being 26.00/24.40, 28.07/40.94, and 30.47/27.67 mmol/L, respectively. Except for the AML M subgroup, all groups had a baseline hypokalemia. For the AML, HCZ, and AML-HCZ groups, significant (P.0001) M/F hypokalaemic alterations were 0.23/0.35, 0.76/0.53, and 0.18/0.19 mmol/L, respectively. For the AML, HCZ, and AML-HCZ groups, the corresponding significant (P.0001) M/F increases in urine K+ were 4.60/5.71, 10.67/18.60, and 8.2/9.3 mmol/L, respectively. At baseline, all groups had significant (P=.05) disproportionate chloraemia. The M/F hypochloraemic changes in the AML, HCZ, and AML-HCZ groups were 10.60/11.46, 25.60/26.94, and 22.93/17.67, respectively, and were significant (P.0001). All groups had substantial parallel hyperchloriuria (P.0001), with M/F values of 8.09/6.46, 26.00/39.86, and 24.53/18.00 mmol/L in the AML, HCZ, and AML-HCZ groups, respectively.
Conclusion: Long-term AML and HCZ combination therapy, while beneficial, causes biochemical alterations such as Na+, K+, and Cl- depletion, necessitating serum electrolytes monitoring and K+ supplementation or concomitant use of a K+-sparing diuretic. The patients' strong natriuresis and diuresis suggest that they were salt-sensitive, and that salt reduction as a lifestyle intervention for hypertension control could be beneficial.Author(S) Details
Godfrey B. S. Iyalomhe
Department of Pharmacology and Therapeutics, College of Medicine, Ambrose Alli University, Ekpoma, Nigeria.
Eric K. I. Omogbai
Department of Pharmacology and Toxicology, University of Benin, Benin City, Nigeria.
Osigbemhe O. B. Iyalomhe
Department of Physiology, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA.
Sarah I. Iyalomhe
Department of Public Health and Primary Healthcare, Central Hospital Auchi, Nigeria.
View Book:- https://stm.bookpi.org/RDMMR-V6/article/view/4540
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