Hoes AW, Grobbee DE, Lubsen J, Man in't Veld AJ, van der Does E, Hofman A.
Diuretics, beta-blockers , and the risk for sudden cardiac death in hypertensive patients

Ann Int Med (Oct) 123:481-487 1995

Diuretics and beta-blockers have been recommended as first-line therapy for hypertension, yet there have been concerns raised re the safety of these agents. In this case- control study, 257 patients who suffered sudden cardiac death while receiving drug therapy for hypertension were compared to 257 living controls also receiving drug therapy for hypertension. Information on medication use and clinical characteristics was collected from medical files. Antihypertensive meds were categorized into 4 groups: non-potassium sparing diuretics without beta-blockers; beta- blockers without non-potassium sparing diuretics; non-potassium sparing diuretics and beta blockers used together; and other medications (reference group). Potential confounders included history of cardiovascular disease (MI, CHF, angina, CVA, claudication, arrhythmias), cv risk factors (smoking, cholesterol, body weight, LVH), digitalis use, and comorbid conditions (diabetes, kidney dis, COPD). The asssociation between antihypertensive meds and sudden death was determined using conditional logistic regression. Potential confounders were added to the multivariate model in a stepwise fashion.

After adjustment for potential confounders, patients receiving non-potassium spring diuretics had an increased risk for sudden cardiac death (RR 1.8, CI 1.0-3.1) compared to the reference group (treated primarily with potassium-sparing diuretics). Risks for beta-blocker use, non-potassium sparing diuretics without beta-blockers, and non-potassium sparing diuretics and beta-blockers were 1.7 (1.1-2.6), 2.2 (1.1-4.6), and 1.4 (0.6-3.0), respectively. The risk for patients receiving beta-blockers without non-potassium sparing diuretics was 1.8 (1.1-2.9).

The authors conclude that the use of non-potassium sparing diuretics and beta-blockers is associated with an increased risk of sudden cardiac death. It should be noted however that concomitant use of beta-blockers and non-potassium-sparing diuretics decreased the risk associated with use of the latter agents alone. Furthermore, beta-blockers have been shown to be protective vs. sudden cardiac death in other studies. (Leehey)

To go back use the BACK button on your browser.
Otherwise click on the desired link to this article below:
H: Special problems : Outcomes
H: Drug therapy : Diuretics