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ANTIHYPERTENSIVE AGENTS AND SUDDEN CARDIAC DEATH.

Although randomized trials have shown that diuretics and beta-blockers reduce morbidity and mortality in hypertensive patients, some studies suggest that these drugs may increase the risk for sudden cardiac death. This case- control study from the Netherlands examined whether non- potassium-sparing diuretics and beta-blockers are indeed associated with sudden death. Researchers compared 257 case-patients who were taking antihypertensive agents at the time of death (presumably sudden cardiac death) with 257 living controls also taking antihypertensives. Compared with controls, case patients had an increased incidence of cardiovascular disease, including myocardial infarction, heart failure, and angina. They also had slightly lower blood pressure and were more likely to smoke. After adjustment for these factors, patients receiving non-potassium-sparing diuretics were almost twice as likely as a reference group primarily treated with potassium-sparing diuretics to have sudden death (relative risk, 1.8; confidence interval, 1.0 to 3.1). The risk was similarly increased for patients taking beta-blockers (RR, 1.7; CI, 1.1 to 2.6). Comment: This study is likely to raise controversy about the role of non-potassium-sparing diuretics and beta- blockers in treating hypertension. However, it is important to remember that multiple large, randomized, placebo- controlled trials have shown that these agents are more beneficial than harmful for hypertension -- and the current findings don't negate that proven efficacy. Randomized trials showing that other agents are more beneficial would be needed before a change in practice could be recommended.

— CD Mulrow

Published in Journal Watch General Medicine October 17, 1995

Citation(s):

Hoes AW, et al. Diuretics, beta-blockers, and the risk for sudden cardiac death in hypertensive patients. Ann Intern Med 1995 Oct 1 123 481-487.

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