A Pilot Study Comparing Furosemide and Hydrochlorothiazide in Patients With Hypertension and Stage 4 or 5 Chronic Kidney Disease
Article first published online: 9 DEC 2011
© 2011 Wiley Periodicals, Inc.
The Journal of Clinical Hypertension
Volume 14, Issue 1, pages 32–37, January 2012
How to Cite
Dussol, B., Moussi-Frances, J., Morange, S., Somma-Delpero, C., Mundler, O. and Berland, Y. (2012), A Pilot Study Comparing Furosemide and Hydrochlorothiazide in Patients With Hypertension and Stage 4 or 5 Chronic Kidney Disease. The Journal of Clinical Hypertension, 14: 32–37. doi: 10.1111/j.1751-7176.2011.00564.x
- Issue published online: 3 JAN 2012
- Article first published online: 9 DEC 2011
- Manuscript received: August 3, 2011; Revised: October 3, 2011; Accepted: October 4, 2011
Furosemide is the diuretic of choice for the treatment of hypertension in chronic kidney disease but the adaptative changes in the distal nephron may decrease its efficacy. Hydrochlorothiazide is not believed to be efficient in this setting. In a randomized, double-blind, cross-over trial, 23 patients with hypertension and stage 4 or 5 chronic kidney disease received long-acting furosemide (60 mg) and hydrochlorothiazide (25 mg) for 3 months and then both diuretics for 3 months. Sodium and chloride fractional excretions were measured after 3 months of each diuretic and then after their association. A trend towards an increase in the fractional excretion of sodium and chloride was observed with furosemide and hydrochlorothiazide (P=not significant). The association of the two diuretics increased the fractional excretions of sodium and chloride from 3.4±1.8 to 4.9±2.8 and from 3.8±2.0 to 6.0±3.1, respectively (P<.05). Furosemide and hydrochlorothiazide decreased mean blood pressure by the same extent. The association of the two diuretics was more efficient on blood pressure. There were no differences between furosemide and hydrochlorothiazide with respect to natriuresis and blood pressure control in patients with hypertension and chronic kidney disease.