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Diuretics and Sudden Cardiac Death
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
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Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
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TO THE EDITOR:
Hoes and associates [1] showed an increased risk for sudden cardiac death in hypertensive patients receiving non-potassium-sparing diuretics compared with a reference group, which primarily received potassium-sparing diuretics. The authors attributed this detrimental effect to the hypokalemia and hypomagnesemia produced by the non-potassium-sparing diuretics.
Given the antiarrhythmic effect of the potassium-conserving diuretic amiloride in suppressing ventricular premature contractions and runs of ventricular tachycardia [2], the difference in the rate of sudden cardiac death may be explained by a reduced risk for death from cardiac arrhythmia in the patients receiving potassium-sparing diuretics rather than by an absolute increase in the rate of deaths in the patients treated with non-potassium-sparing diuretics.
During the past several years, I have given amiloride to approximately 24 patients with mild hypertension and symptomatic, but nonrepetitive, ventricular premature contractions. Approximately half of these patients had symptomatic and objective improvement in the frequency and severity of the ventricular premature contractions with no obvious side effects. This clinical response to amiloride is roughly equivalent to the response to class I antiarrhythmic agents and is associated with considerably fewer side effects.
Given the above observations, a randomized, double-blind study comparing a potassium-sparing diuretic such as amiloride with placebo might be of value in proving the hypothesis that potassium-sparing diuretics may prolong life.
Michael S. Horowitz, MD
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
