Differences in antihypertensive effect were due to potency rather than efficacy .
This synthesis accomplishes for PSDs what has already been achieved for thiazide-type diuretics and other antihypertensives and can guide the application of these underutilized medicines
BACKGROUND Potassium-sparing diuretics ( PSDs ) are valuable antihypertensives with additional benefits unrelated to control of systolic blood pressure ( SBP ) .
However , their key parameters affecting SBP and serum potassium are poorly defined , fostering underutilization .
Treatment of elderly hypertensive patients with epithelial sodium channel inhibitors combined with a thiazide diuretic reduces coronary mortality and sudden cardiac death.
BACKGROUND No reduction in either coronary mortality or sudden cardiac death ( SCD ) has been demonstrated in overviews of r and omized trials of treatment of hypertension with diuretics . METHODS An overview was conducted of coronary mortality and SCD in r and omized controlled antihypertensive trials in which an  epithelial sodium channel ( ENaC ) inhibitor/ hydrochlorthiazide ( HCTZ ) combination was used . Secondarily , an analogous overview in which thiazide diuretic was used alone was performed . R and omized trials that used an ENaC inhibitor/ HCTZ combination ( or , alternatively , thiazide diuretic alone ) were identified from previous meta-analyses , search es of PubMed , search of the Cochrane Clinical Trials data base , and review of publications that addressed the consequences of treating hypertension . Trials in which participants were r and omized to either an ENaC inhibitor combined with a thiazide diuretic ( or to a thiazide diuretic alone ) or to control treatment for at least one year and in which coronary mortality was reported were included . Numbers of events in individual trials were abstract ed independently by 2 authors . RESULTS Significant reductions in both coronary mortality and SCD were observed in the overview of trials in which elderly patients received an ENaC inhibitor/ HCTZ combination . The odds ratio ( OR ) for coronary mortality was 0.59 ( 95 % confidence interval [ CI ] 0.44 , 0.78 ) and for SCD was 0.60 ( 95 % CI 0.38 , 0.94 ) . In contrast , an overview of the trials using thiazide diuretics alone showed no significant reductions of either coronary mortality ( OR 0.94 ; 95 % CI 0.81 , 1.09 ) or SCD ( OR 1.27 ; 95 % CI 0.93 , 1.75 ) . CONCLUSIONS Use of an ENaC inhibitor combined with HCTZ for treatment of hypertension in the elderly results in favorable effects on coronary mortality and SCD
Differences in antihypertensive effect were due to potency rather than efficacy .
This synthesis accomplishes for PSDs what has already been achieved for thiazide-type diuretics and other antihypertensives and can guide the application of these underutilized medicines
BACKGROUND Potassium-sparing diuretics ( PSDs ) are valuable antihypertensives with additional benefits unrelated to control of systolic blood pressure ( SBP ) .
However , their key parameters affecting SBP and serum potassium are poorly defined , fostering underutilization .