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)
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H: Special problems :
Outcomes
H: Drug therapy :
Diuretics