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Effect of diuretics on plasma aldosterone and potassium in primary hypertension: A systematic review and meta-analysis
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  • Ryan McNally,
  • Bushra Farukh,
  • P J Chowienczyk,
  • Luca Faconti
Ryan McNally
King's College London

Corresponding Author:ryan.mcnally@kcl.ac.uk

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Bushra Farukh
King's College London
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P J Chowienczyk
King's College London
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Luca Faconti
King's College London
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Abstract

Aim: Different to inhibitory drugs of the renin-angiotensin-aldosterone system (RAAS), diuretics are known to decrease blood pressure (BP) and stimulate renin release by the kidneys. Despite plasma aldosterone (PA) level is mostly regulated by the RAAS activity, serum potassium has been shown to be an important factor in animal models and humans. Here we perform a systematic review and meta-analysis of randomized-controlled trials investigating the effects of diuretic therapy on PA and its correlation with change in potassium and BP. Methods: Three databases were searched: MEDLINE, EMBASE and The Cochrane Central Register of Controlled Trials (CENTRAL). Titles were firstly screened by title and abstract for relevancy before full-text articles were assessed for eligibility according to a pre-defined inclusion/exclusion criteria. Results: A total of 1139 articles were retrieved of which 45 met the pre-specified inclusion/exclusion criteria. The average standardised difference in mean PA change was similar for all classes of diuretic (mean, 95% CI); thiazide/thiazide-like 0.304 (0.169, 0.440), loop 0.927 (0.37, 1.49), MRA/potassium-sparing 0.264 (0.174, 0.355) and combination 0.466 (0.142, 0.789), Q = 6.475, P = 0.091. In subjects previously untreated with another antihypertensive, there was a significant relationship between PA change and change in systolic BP but no relationship with the change in potassium. Conclusion: In RCTs of diuretic therapy in hypertension, there is an increase in PA with all classes of diuretic and no between-class heterogeneity. Change in PA is not related with potassium but correlates to the change in BP in subjects previously untreated with another antihypertensive medication.
24 May 2021Submitted to British Journal of Clinical Pharmacology
26 May 2021Submission Checks Completed
26 May 2021Assigned to Editor
01 Jun 2021Reviewer(s) Assigned
05 Aug 2021Review(s) Completed, Editorial Evaluation Pending
11 Aug 2021Editorial Decision: Revise Major
08 Oct 20211st Revision Received
09 Oct 2021Submission Checks Completed
09 Oct 2021Assigned to Editor
09 Oct 2021Review(s) Completed, Editorial Evaluation Pending
30 Oct 2021Editorial Decision: Revise Minor
01 Nov 20212nd Revision Received
02 Nov 2021Submission Checks Completed
02 Nov 2021Assigned to Editor
02 Nov 2021Review(s) Completed, Editorial Evaluation Pending
13 Nov 2021Editorial Decision: Accept
May 2022Published in British Journal of Clinical Pharmacology volume 88 issue 5 on pages 1964-1977. 10.1111/bcp.15156