Current guidelines call for using a thiazide diuretic alone as the initial treatment for hypertension. But research has shown that although thiazide diuretics such as hydrochlorothiazide can control hypertension, they don't reduce mortality. What's more, they can cause problems in older adults by triggering potassium loss, which may lead to cardiac dysrhythmias.

New research suggests a more effective alternative for older adults: combining a thiazide diuretic with a potassium-sparing epithelial sodium channel (ENaC) inhibitor such as amiloride. In a meta-analysis, researchers compared the benefits of a thiazide alone with a thiazide/ENaC inhibitor combination and found that using a thiazide with an ENaC inhibitor reduced the risk of death from heart-related causes by about 40%. Using only a thiazide diuretic didn't reduce the risk of death. Researchers hypothesize that the benefits of reduced BP from a diuretic may be offset by the increased risk of cardiac dysrhythmias.

Researchers say their results support using a thiazide and an ENaC inhibitor as first-line therapy for hypertension in older adults. Further study is needed to determine if this regimen is appropriate for younger patients.

Source: Hebert PR, Coffey CS, Byrne DW, et al. Treatment of elderly hypertensive patients with epithelial sodium channel inhibitors combined with a thiazide diuretic reduces coronary mortality and sudden cardiac death. J Am Soc Hypertens. 2008;2(5):355-365.