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Diuretics, Potassium, and Ventricular Arrhythmias-Reply FREE

David Siegel, MD, MPH; Stephen B. Hulley, MD, MPH
JAMA. 1992;268(1):53-53. doi:10.1001/jama.1992.03490010054022
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In Reply.  —We agree with Drs Clarfield, Friedman, and Bergman that hypertension is an important risk factor in the elderly; in fact, some of our previous work is on this topic.1 However, the present study focused on middle-aged men because the goal was to examine findings in the Multiple Risk Factor Intervention Trial (MRFIT), which found an association between diuretic therapy (especially hydrochlorothiazide) and an increased rate of sudden death in hypertensive men 35 to 57 years of age with electrocardiographic abnormalities.2 In our study, we extended the age range to 35 to 70 years. It is of interest that the Systolic Hypertension in the Elderly Program study cited by Clarfield and colleagues restricted enrollment to individuals 60 years and above. There may be research questions [ill] most appropriate for particular age groups.In general, we agree with the thrust of Dr Papademetriou's work, which indicates that hydrochlorothiazide

REFERENCES

Siegel D, Kuller L, Lazarus N, et al.  Predictors of cardiovascular events in the Systolic Hypertension in the Elderly Project (SHEP). Am J Epidemiol . 1987;;126: 385-399.
Multiple Risk Factor Intervention Trial Research Group.  Baseline rest electrocardiographic abnormalities, anitihypertensive treatment, and mortality in the Multiple Risk Factor Intervention Trial. Am J Cardiol . 1985;;55:1-15.
Papademetriou V, Burris JF, Notargiacomo A, Fletcher RD, Freis ED.  Thiazide therapy is not a cause of arrhythmia in patients with systemic hypertension. Arch Intern Med . 1988;;148:1272-1276.
Papademetriou V, Fletcher RD, Khatri IM, Freis ED.  Diuretic-induced hypokalemia in uncomplicated systemic hypertension: effect of plasma potassium correction on cardiac arrhythmias. Am J Cardiol . 1983;;52:1017-1022.
Siegel D, Hulley SB, Black DM, et al.  Diuretics, serum and intracellular electrolyte levels, and ventricular arrhythmias in hypertensive men. JAMA . 1992;;267:1083-1089.
Hollifield JW.  Potassium and magnesium abnormalities: diuretics and arrythmias in hypertension. Am J Med . 1984;;77:28-32.
Holland OB, Nixon JV, Kuhnert L.  Diuretic-induced ventricular ectopic activity. Am J Med . 1981;;70:762-768.

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Siegel D, Kuller L, Lazarus N, et al.  Predictors of cardiovascular events in the Systolic Hypertension in the Elderly Project (SHEP). Am J Epidemiol . 1987;;126: 385-399.
Multiple Risk Factor Intervention Trial Research Group.  Baseline rest electrocardiographic abnormalities, anitihypertensive treatment, and mortality in the Multiple Risk Factor Intervention Trial. Am J Cardiol . 1985;;55:1-15.
Papademetriou V, Burris JF, Notargiacomo A, Fletcher RD, Freis ED.  Thiazide therapy is not a cause of arrhythmia in patients with systemic hypertension. Arch Intern Med . 1988;;148:1272-1276.
Papademetriou V, Fletcher RD, Khatri IM, Freis ED.  Diuretic-induced hypokalemia in uncomplicated systemic hypertension: effect of plasma potassium correction on cardiac arrhythmias. Am J Cardiol . 1983;;52:1017-1022.
Siegel D, Hulley SB, Black DM, et al.  Diuretics, serum and intracellular electrolyte levels, and ventricular arrhythmias in hypertensive men. JAMA . 1992;;267:1083-1089.
Hollifield JW.  Potassium and magnesium abnormalities: diuretics and arrythmias in hypertension. Am J Med . 1984;;77:28-32.
Holland OB, Nixon JV, Kuhnert L.  Diuretic-induced ventricular ectopic activity. Am J Med . 1981;;70:762-768.
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