Reversal of diuretic-induced secondary hyperaldosteronism and hypokalemia by enalapril (MK-421): a new angiotensin-converting enzyme inhibitor.
The study reported here prospectively evaluated the prevention of diuretic-induced secondary hyperaldosteronism and hypokalemia by a converting enzyme inhibitor, enalapril (MK 421). Eighteen normal subjects were randomized into three groups: (1) a HCTZ group (hydrochlorothiazide (HCTZ) 50 mg/day); (2) a MK-421 group (MK-421 10 mg/day); and (3) a HCTZ + MK-421 group [HCTZ 50 mg/day plus MK-421 10 mg/day]. Following a five-day control and a 28-day treatment period, the HCTZ group demonstrated an attenuated but persistent secondary hyperaldosteronism and hypokalemia, the MK-421 group manifested a gradual decline in aldosterone secretion, and the HCTZ + MK-421 group had a delayed but effective correction of secondary hyperaldosteronism and hypokalemia at 28 days but not before. In conclusion, MK-421 reversed diuretic-induced secondary hyperaldosteronism and hypokalemia after 28 days of hydrochlorothiazide therapy. Therefore, converting enzyme inhibitors, such as enalapril, provide useful adjunctive therapy in diuretic-treated patients, but potassium supplementation may be required before the start of four weeks of combined therapy.
D000806:Angiotensin-Converting Enzyme Inhibitors; D004151:Dipeptides / Q000627:therapeutic use*; D004232:Diuretics / Q000009:adverse effects* / Q000037:antagonists & inhibitors*; D004573:Electrolytes / Q000378:metabolism; D004656:Enalapril; D006801:Humans; D006852:Hydrochlorothiazide / Q000037:antagonists & inhibitors; D006929:Hyperaldosteronism / Q000139:chemically induced / Q000517:prevention & control*; D007008:Hypokalemia / Q000139:chemically induced / Q000517:prevention & control*; D011897:Random Allocation; D012083:Renin / Q000097:blood
D000806:Angiotensin-Converting Enzyme Inhibitors; D004151:Dipeptides; D004232:Diuretics; D004573:Electrolytes; D006852:Hydrochlorothiazide; D004656:Enalapril; D012083:Renin