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Electrolyte disarray and cardiovascular disease

  • John W. Hollifield
    Correspondence
    Address for reprints: John W. Hollifield, MD, Hypertension Center of Nashville, 1900 Patterson Street, Nashville, Tennessee 37203.
    Affiliations
    From the Department of Medicine, the University of Tennessee, Nashville, Tennessee U.S.A.
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      Abstract

      Thiazide diuretics have frequently been recommended as initial therapy in patients with mild to moderate hypertension. However, their undesirable metabolic consequences have been suspected of contributing to increases in cardiovascular morbidity and mortality. Even at low doses, there is a definite decrease in both potassium and magnesium levels. The degree of decrease in potassium and magnesium levels has been shown to be directly related to the hydrochlorothiazide dosage. Many investigators have now reported an increase in ventricular ectopy associated with diuretic-induced hypokalemia. Whereas there is no single study that conclusively proves that thiazide therapy results in malignant arrhythmias and an increased risk of sudden death, the circumstantial evidence is strong. Although sodium restriction is critical to potassium restoration, it rarely works alone. Potassium chloride supplementation can be effective in restoring potassium but not magnesium. Potassium-sparing diuretic combinations can both prevent and treat hypokalemia and hypomagnesemia, possibly reducing the risk of potentially lethal arrhythmias and sudden death.
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      References

      1. JAMA. 1977; 237: 255-261
      2. Arch Intern Med. 1980; 140: 1280-1285
      3. Arch Intern Med. 1984; 144: 1045-1057
      4. Arch Intern Med. 1988; 148: 1023-1038
        • Moser M
        A decade of progress in the management of hypertension.
        Hypertension. 1983; 5: 808-813
        • Multiple Risk Factor Intervention Trial Research Group
        Baseline rest electrocardiographic abnormalities, antihypertensive treatment, and mortality in the Multiple Risk Factor Intervention Trial.
        Am J Cardiol. 1985; 55: 1-15
        • Hollifield JW
        Potassium and magnesium abnormalities: diuretics and arrhythmias in hypertension.
        Am J Med. 1984; 77: 28-32
        • Hollifield JW
        Thiazide treatment of hypertension: effects of thiazide diuretics on serum potassium, magnesium, and ventricular ectopy.
        Am J Med. 1986; 80: 8-12
        • Hollifield JW
        • Slaton PE
        Thiazide diuretics, hypokalemia, and cardiac arrhythmias.
        Acta Med Scand. 1981; 647 (suppl): 67-73
        • Holland OB
        • Nixon JV
        • Kuhnert L
        Diuretic-induced ventricular ectopic activity.
        Am J Med. 1981; 70: 762-768
        • Medical Research Council Working Party on Mild to Moderate Hypertension
        Ventricular extrasystoles during thiazide treatment: substudy of MRC mild hypertension trial.
        Br Med J. 1983; 287: 1249-1253
        • Veterans Administration Cooperative Study Group on Antihypertensive Agents
        Effects of treatment on morbidity in hypertension. II. Results in patients with diastolic blood pressure averaging 90 through 114 mm Hg.
        JAMA. 1970; 213: 1143-1152
        • Hypertension-Stroke Cooperative Study Group
        Effect of antihypertensive treatment on stroke recurrence.
        JAMA. 1974; 229: 409-418