Abstract
Diuretic drugs (both thiazide and loop diuretics) have been the mainstay of treatment for arterial hypertension and congestive heart failure [1,3]; however, the prolonged use of thiazide diuretics and (to a lesser extent) of loop-acting diuretics is accompanied by a variable depression of serum and tissue levels of potassium and magnesium and reduced concentrations of sodium-potassium pumps in muscle [4–6]. These diuretic - induced electrolytic disturbances have been associated with cardiac arrhythmias (ventricular ectopic activity [7,8], torsade de pointes [9] and sudden death), especially in elderly patients with hypertension, left ventricular hypertrophy, and/or congestive heart failure [9,10], although in a Editorial Review the cardiotoxicity of diuretics is thought to be the result of “much speculation and little substance” [11].
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Joint National Committee on the Detection, Evaluation and Treatment of High Blood Pressure (1993) The Fifth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC-V), Arch, intern. Med. 153, 154–183.
Chalmers J and Zanchetti A. (1996) The 1996 report of a World Health Organization expert committee on hypertension control, J Hypertens 14, 929–33.
Cohn, J.N. (1996) Management of chronic heart failure, N. Engl. J. Med. 335, 490–498.
Dycker, T. and Wester, P.O. (1987) Potassium/ Magnessium depletion in patients with cardiovascular disease, Amer. J. Med. 82(Suppl. 3A), 11–17.
Dorup, I., Skajaa, K., Clausen, T. and Kjelden, K. (1988) Reduced concentrations of potassium, magnesium and sodium - potassium pumps in human skeletal during treatment with diuretics, Brit. Med. J. 296, 455–58.
Nicholls, M.G. (1990) Interaction of diuretics and electrolytes in congestive heart failure, Am. J. Cardiol. 65, 17E–21.
Holland, O.B, Kuhnert, L., Pollard, J., Padia, M., Anderson, RJ and Blomqvist, G. (1988) Ventricular ectopic activety with diuretic therapy, Am. J. Hypertens. 1, 380–85.
Hollifield J.W. (1989) Thiazide treatment of systemic hypertension: effects on serum magnesium and ventricular ectopic activity, Am J Cardiology 63, 22G–25.
Singh, B-N., Hollenberg, N.K., Poole - Wilson, P.A. and Robertson, J.S. (1992) Diuretic induced potassium and magnesium deficiency: relation to drug - induced QT prolongation, cardiac arrhythmias and sudden death, J Hypertens. 10, 301–16.
Nicholls, M.G. (1988) Age related effects of diuretics in hypertensive subjects, J Cardiovas Pharmacol. 12 (Supp.8), 51–59.
Mclnnes, G.J., Yeo, W.W., Ramsay, L.E. and Moser M. (1992) Cardiotoxicity and diuretics: much speculation - little substance, J Hypertens. 10, 317–335.
Melby J.C. (1986) The renin - angiotensin - aldosterone complex, Am. J. Med. 81 (Suppl.4C), 8–12.
Prichard, B.N., Owens, C.W., and Woolf, A.S (1992) Adverse reactions to diuretics, Eur. Heart J. 13 (Suppl.G), 96–103.
Wester, P.O. (1992) Electrolyte balance in heart failure and the role for magnesium ions, Am J Cardiol. 70, 4C–49C.
Priewer H, Ullrich F, Mutschler E. (1996) Potassium and magnesium retaining potency and efficacy of triamterene and analogues in concious saline - loaded rats, Magnes Res. 9, 33–40.
Malini P.L., Strocchi E., Valtancoli G., Ambrosioni E. (1990) Angiotensin converting enzyme inhibitors, thiazide diuretics and magnesium balance. A preliminary study Magnes Res. 3, 193–96.
American Society of Hypertension (1992): Recommendations for routine blood pressure measurement by indirect cuff sphygmomanometry, Am J Hypertens. 5, 207–9.
Wallenstein S., Zucker C.L., and Fleiss J.L. (1980) Some statistical methods useful in circulation research, Circ Res. 47, 1–9.
Siegel D., Hulley B., Black D.M., Oheitlin M.D., Sebastian A, Seeley D.G. (1992) Diuretics, serum and intracellular electrolyte levels, and ventricular arrhythmias in hypertensive men, JAMA 67, 1083–89.
Freis E.D. (1990) The cardiotoxicity of thiazide diuretics Review of the evidence, J Hypertens. 8 (Suppl.), S23–32.
Ikram H. (1987) Arrhythmias, electrolytes, and ACE inhibitor therapy in the Elderly, Gerontology 33 (Suppl.1), 42–47.
Morris M.E. (1992) Brain and CSF magnesium concentrations during magnesium deficit in animals and humans: neurologic symptoms, Magnes Res. S: 303–313.
Wester P.O., Dyckner T, (1981) Diuretic treatment and Magnesium losses, Acta Med. Scand. 209 (Suppl.), 145–52.
Delhnmean A., Granry J.C., Monrigal J.P., Costerousse F. (1995) Indication for the use of magnesium in anesthesia and intensive care, Ann. Fr. Anesth. Reanim. 14, 406–16.
O’ Keeffe, Grimes H., Finn J., McMurrough P., Daly K. (1992) Effect of Captopril therapy on lymphocyte potassium and magnesium concentrations in patients with congestive heart failure, Cardiology 80, 100–105.
Schminger R.H. and Erdmann E. (1992) Heart failure and electrolyte disturbances, Methods, Find Exp Clin Pharmacol. 14, 315–25.
Leary W.P., Reyes A.J., van der Byl K. (1992) Effects of angiotensin-converting enzyme inhibitors on urinary excretions: Interactions with diuretics, Am J Med,. 92 (Suppl 4B), 4B–68S.
Simunic M., Rumboldt Z., Ljutic D., Sardelic S. (1995) Ramipril decreases chlortha-lidone - induced loss of magnessium and potassium in hypertensive patients. J Clin Pharmacol 35, 1150–55.
Riegger A.J. (1989) ACE inhibitors in congestive heart failure, Cardiology, 76 (Suppl.2), 42–49.
Dietz R., Osterziel K.J. (1988) Effects of angiotensin-converting enzyme inhibitors in heart failure, Z Kardiol. 77 (Suppl.3), 89–93.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1997 Kluwer Academic Publishers
About this chapter
Cite this chapter
Efstratopoulos, A.D., Voyaki, S.M., Meikopoulos, M.A. (1997). Alterations of Serum Magnesium under Chronic Therapy with Diuretics and/or Angiotensin - Converting Enzyme Inhibitors in Hypertensive Patients. In: Theophanides, T., Anastassopoulou, J. (eds) Magnesium: Current Status and New Developments. Springer, Dordrecht. https://doi.org/10.1007/978-94-009-0057-8_42
Download citation
DOI: https://doi.org/10.1007/978-94-009-0057-8_42
Publisher Name: Springer, Dordrecht
Print ISBN: 978-94-010-6515-3
Online ISBN: 978-94-009-0057-8
eBook Packages: Springer Book Archive