Moderate sodium restriction and various diuretics in the treatment of hypertension

Abstract

Changes in total body K level and blood pressure (BP) were determined in multiple studies on 12 hypertensive subjects ingesting a diet either moderately restricted or higher in Na. On both diets, the diuretics chlorthalidone, hydrochlorothiazide, or furosemide were randomly given for 4 wk intervals. Total body exchangeable K level fell 225 meq with lower Na intake and 455 meq with higher intake, combining all diuretics. Chlorthalidone caused more K wastage than other diuretics. The average falls in mean BP were 13.9 mm Hg with the lower Na diet and 9.1 with the higher Na diet, combining all diuretics. Combining both diets, chlorthalidone produced the greatest fall and furosemide produced the slightest. If a diuretic is used to treat hypertension, a diet moderately restricted in Na and a single morning dose of a diuretic of intermediate duration of action apparently offer the best balance of efficacy and safety for most patients.