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Sudden Cardiac Death in Patients with Hypertension

An Association with Diuretics and β-Blockers?

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Summary

The cornerstones of current antihypertensive treatment are diuretics and β-blockers and the efficacy of these drugs in preventing cardiovascular disease is undisputed. This article focuses on the effect of these 2 drug classes on the incidence of sudden death.

Numerous studies have shown that thiazide diuretics have a strong, dosagedependent potassium-depleting effect, and it has been postulated that this may explain why the reduction in risk of coronary heart disease, observed in hypertension trials, was less pronounced than expected. In 7 trials that included sudden death as an end-point, a pooled risk-ratio of sudden death of 1.5 (95% confidence interval 1.1 to 2.0) was observed when non-potassium-sparing diuretics were compared with placebo. Two recent case-control studies have also strongly indicated that the use of thiazides increases the risk of sudden death. Evidence from trials using potassium-sparing diuretic combinations suggests that these may be better tolerated than thiazide monotherapy.

Although it was suggested in the 2 recent case-control studies that recipients of β-blockers are also at an increased risk of sudden death, further studies are required to confirm this finding, particularly since these drugs have several well-documented cardioprotective effects.

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Authors and Affiliations

  1. Julius Center for Patient-Oriented Research, Utrecht University/Academic Hospital Utrecht, Universiteitsweg 100, 3581 CG, Utrecht, The Netherlands

    Arno W. Hoes & Diederick E. Grobbee

  2. Department of General Practice, Utrecht University/Academic Hospital Utrecht, Utrecht, The Netherlands

    Arno W. Hoes

  3. SOCAR Research SA, Givrins, Switzerland

    Jacobus Lubsen

Authors
  1. Arno W. Hoes
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  2. Diederick E. Grobbee
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  3. Jacobus Lubsen
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Correspondence to Arno W. Hoes.

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Hoes, A.W., Grobbee, D.E. & Lubsen, J. Sudden Cardiac Death in Patients with Hypertension. Drug-Safety 16, 233–241 (1997). https://doi.org/10.2165/00002018-199716040-00001

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