What are my options for a diuretic for hypertension, considering that my potassium runs low

In My Humble Opinion
1

I have hypertension, I’m currently on an ARB and CCB (100mg losartan and 10mg amlodipine). They help a bit, but not a lot. My BP still runs about 160/100.

In the past, I’ve tried the diuretic chlorothiazide. It took about 20 points off my systolic and 10 points off my diastolic. However my blood potassium runs low. Even with the ARB, which is supposed to increase potassium levels, my blood potassium is about 3.6, on the chlorothiazide it dropped to about 3.0 and I started having severe back pain. The doctor tried potassium supplements and I tried a high potassium diet, but that just gave me a whole new list of side effects. After I quit the chlorothiazide my blood potassium rebounded up to about 3.6-3.7.

In the past I’ve tried hydrochlorothiazide, but I don’t think it works as well. However I used that in my 20s, and I’m in my 40s now. I suppose its an option. Its my understanding that HCTZ doesn’t lower potassium as much. But my body in middle age may not be able to handle the effects on potassium levels as well as it did in my 20s, I’m not sure.

A doctor said spironolactone could be an option. An issue though is that in my life I’ve had issues with my adrenals and HPA axis, as well as issues with depression. Its my understanding that spironolactone can cause mood changes and change cortisol levels.

I’ve tried beta blockers. They make me depressed and don’t lower my BP. They do lower my heart rate, but not my BP. I’m kind of worried other sympatholytics like clonidine or alpha blockers will also cause depression. I’ve finally gotten my depression into remission in the last year, and don’t want to trigger it back into active status.

I’m curious if anyone has ideas for what else I can try. I know there are lifestyle interventions (weight loss, isometric hand grip exercises, etc).

But as far as medication, is there a diuretic I can try that’ll lower my BP, keep my potassium levels stable and not cause mood disorders or mess with my HPA axis?

Would combining HCTZ with a potassium sparing diuretic be a good idea? I’m scared to take spironolactone, but there are 5 others.

I’m just looking for ideas to discuss with my PCP. Is there something other than a diuretic I should try? Its just disappointing because as I said on chlorothiazide my BP dropped about 20/10 points, but my potassium levels bottomed out so badly I got severe back pain that was almost disabling.

2

I take: Clonidine for HB and it doesn’t make me depressed… it does calm my ADD and anxiety down… sort of takes the sharp edges off the day. I’m also taking Verapamil, Metoprolol and Losartan too and managed to get my blood pressure down from eye popping 180+ over 110 to 145 over 89 but I’m on four meds for the high blood…if I forget to take them or run out, after few days I can feel the pressure change in my arteries and veins… it weird to have your blood pressure be low for long periods then suddenly jump up when you forget to take the medicine for a few days… you feel the effect of your heart beating in your arteries and the sensation of the blood moving around your circulatory system, the roaring in your ears and the room vibrating like your on a ship because of your eyes quivering due to the hydraulic water hammering effect of your heart beating….

3

This acts as a water pill that does not wash the minerals out of your system. Also many other uses from teen acne to womens hair loss called alopcia.

For me it has the side effect of turning my grey hair back to the original color. Grey hair falls out, brown hair comes in.

4

I’ve been on hydrochlorothiazide and the spironolactone too… the hydrochlorothiazide gave me Charley horses and random muscle spasms…

As for the Spironolactone it made me grow boobs… just throwing that out there for you if you’re a guy… I actually started having sensitive areas around my chest like women do… i would bump into some thing with my Moob (man boob) and be in pain… female coworkers and relatives teased me about that’s what women go through during time of the month… gave me a whole new perspective on and understanding of what women go through….
I don’t take either of them any more. For these reason.

5

There’s also amiloride and triamterene in the potassium-sparing diuretic department, and you wouldn’t have to worry about hormonal interference with either of them.

6

Yeah, thats another reason I’m scared to try spironolactone. Its effects on moods, its effects on cortisol, and its an anti-androgen.

7

Yeah, thats a good idea.

From what I can see, amiloride is a cheap generic and seems to pair well with HCTZ. Maybe I can try a combo of HCTZ and amiloride, see if that lowers my BP without causing low potassium levels.

8

I was surprised at how quickly the sensitivity set in. It was about three weeks before I noticed “growth” in my chest… I take lexapro and don’t know if that helps with the mood swings and I just did not notice…

9

https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/600911

A randomized, double-blind, multicenter study comparing amiloride hydrochloride, amiloride hydrochloride plus hydrochlorothiazide, and hydrochlorothiazide was conducted in 179 patients with mild to moderate essential hypertension (diastolic pressure, 95 to 115 mm Hg). After 12 weeks of treatment, significant reductions in pressure were observed for all three treatment groups. Systolic pressure reduction was greatest for amiloride plus hydrochlorothiazide. Baseline vs 12-week average supine pressures were 153/101 vs 139/93 mm Hg for amiloride, 160/100 vs 137/90 mm Hg for amiloride plus hydrochlorothiazide, and 154/101 vs 134/89 mm Hg for hydrochlorothiazide. Baseline vs treatment mean serum potassium levels were 4.24 vs 4.47 mEq/L for amiloride, 4.24 vs 3.86 mEq/L for the combination, and 4.15 vs 3.56 mEq/L for hydrochlorothiazide.

It could be worth discussing with my PCP, but it still sucks that the amiloride plus hydrochlorothiazide combo still lowered blood potassium by 0.38. Seeing how my potassium levels are borderline low normally, this may cause muscle issues too since it would probably lower my blood potassium levels to 3.2 or so.

It still might be worth trying though, just so long as I get my potassium levels checked.

I suppose I could also try amiloride by itself, see if that helps.

10

But according to this study, the combo is only slightly more effective than either drug alone, and the combo equaled each other out when it comes to blood potassium levels.

11

I’ve been on HCTZ for about 40 years, and for about 30 I’ve also been on time-release potassium chloride tablets (big ones!) specifically to counter the potassium loss. These days I’m also on Losartan and Amlodipine. My blood work gives good numbers all the way around.