The effect of chlorthalidone on ventricular ectopic activity in patients with isolated systolic hypertension

Kostis, John B.; Lacy, Clifton R.; Hall, W. Dallas; Wilson, Alan C.; Borhani, Nemat O.; Krieger, Susan; Cosgrove, Nora M.

doi:10.1016/0002-9149(94)90904-0

Cited by 23 publications

(14 citation statements)

References 26 publications

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“…The low dosage of chlorthalidone used in our study was associated with small and not clinically important metabolic effects (slight hypokalemia; mild increase in urea, triglycerides, and VLDL-cholesterol). This hypokalemia was not associated to with an increase in cardiac arrhythmias as found in the SHEP study 11 . The mechanisms responsible for the antianginal effects of diltiazem have been well investigated and are related to a reduction in oxygen demand due to its negative inotropic and chronotropic effects and to improvement in oxygen supply by coronary vasodilatation and by an increased diastolic time 12 .…”

Section: Discussionsupporting

confidence: 58%

Effects of chlorthalidone and diltiazem on myocardial ischemia in elderly patients with hypertension and coronary artery disease

Serro-Azul¹,

Paula²,

Gruppi³

et al. 2001

Arq. Bras. Cardiol.

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Section: Discussionsupporting

confidence: 58%

Effects of chlorthalidone and diltiazem on myocardial ischemia in elderly patients with hypertension and coronary artery disease

Serro-Azul¹,

Paula²,

Gruppi³

et al. 2001

Arq. Bras. Cardiol.

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“…As even full doses of diuretics do not precipi tate arrhythmias, however, lower doses are unlikely to be arrhythmogenic. As indicated earlier, in a subgroup of SHEP participants who were evaluated by ambulant electrocar diographic monitoring, there was no differ ence in arrhythmias between (low-dose) di uretic-treated patients compared with place bo-treated controls [10].…”

Section: Dose-response Effects Of Diuretics On Serum Potassium Concensupporting

confidence: 53%

“…In a pro spective, double-blind trial in 212 hyperten sive men randomized to receive placebo or 1 of 5 diuretic treatment programs, no signifi cant increase in ventricular arrhythmias was associated with any of the treatment regimens [9] , The influence of chlorthalidone on ven tricular arrhythmias was also examined in a subgroup of 238 patients in the Systolic Hy pertension in the Elderly Program (SHEP) [10] , No significant changes were observed in the ventricular arrhythmia profiles in either the placebo or diuretic-treated patients. 44 Papademetriou Diuretics.…”

Section: Diuretics Hypokalemia and Cardiac Arrhythmiasmentioning

confidence: 99%

Effect of Diuretics on Cardiac Arrhythmias and Left Ventricular Hypertrophy in Hypertension

Papademetriou¹

1994

Cardiology

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Ventricular arrhythmias pose a serious risk in patients with high blood pressure. The concept that diuretics predispose to life-threatening arrhythmias, however, was originally based solely on observations made in patients with severe congestive heart failure pretreated with digitalis and not in patients with high blood pressure. In hypertensive patients, some studies have also indicated that diuretic therapy may be associated with an increase in premature ventricular beats, though most have failed to demonstrate a conclusive link between hypokalemia and the precipitation of such cardiac arrhythmias. Prospective studies, however, have demonstrated that diuretic therapy had no effect on the incidence of serious ventricular arrhythmias in hypertensive patients whether they had left ventricular hypertrophy (LVH) or not, and neither at rest nor during or immediately following dynamic exercise. Correction of diuretic-induced hypokalemia similarly had no effect on the incidence of ventricular arrhythmias. In hypertensive patients, LVH is an independent and particularly sinister risk factor for cardiovascular morbidity and mortality, and its regression is now a specific goal of antihypertensive therapy. Diuretics have been shown to be at least as effective in that respect as other antihypertensive agents. The Veterans Administration Cooperative Study Group reported that after 2 years of treatment, only hydrochlorothiazide of 6 antihypertensive regimens resulted in significant reduction of left ventricular mass. In the Treatment of Mild Hypertension Study, all the antihypertensive drugs used resulted in reductions in LVH but the diuretic caused a significantly greater reduction than other non-diuretic agents. In the Systolic Hypertension in the Elderly Study, which primarily used diuretics, there was a significant reduction in LVH at 5 years. It is reasonable to conclude, therefore, that diuretics are safe and effective antihypertensive agents, which can no longer be considered arrhythmogenic and which induce LVH regression as effectively as other drugs.

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“…[1][2][3] These drugs reduce cardiovascular morbidity and mortality and all-cause mortality in elderly hypertensive patients. 3 Much attention has been paid to diuretics induced hypokalaemia, 4,5 and a combination of low-dose hydrochlorothiazide with potassium sparing diuretic has been recommended to lower the risk of sudden cardiac death. 6 Less attention has been paid to other metabolic alterations such as hyponatraemia, hyperglycaemia, hyperuricaemia, hypercalcaemia and hypercholesterolaemia.…”

Section: Introductionmentioning

confidence: 99%

Diuretic induced hyponatraemia in elderly hypertensive women

et al. 2002

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Diuretics are recommended as first-line antihypertensive treatment in elderly patients. Although attention is usually paid to prevent hypokalaemia with diuretic therapy, risk of hyponatraemia is often ignored. We performed this study to characterise hypertensive patients at increased risk to develop hyponatraemia. We reviewed charts of hypertensive patients hospitalised in Chaim Sheba Medical Center for hyponatraemia from 1990 to 1997. Patients with other causes of hyponatraemia were excluded. The General Practice Maccabi database was used to estimate age and sex distribution of patients prescribed diuretics for hypertension. We identified 180 hypertensive patients (149 F, 31 M; mean age 76.4 ± 9.2 years) hospitalised because of hyponatraemia. Across all age groups, odds ratio (OR) to develop hyponatraemia was three times higher for women vs men (OR 3.10, 95% confidence interval (CI): 2.07-4.67). One hundred

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The effect of chlorthalidone on ventricular ectopic activity in patients with isolated systolic hypertension

Cited by 23 publications

References 26 publications

Effects of chlorthalidone and diltiazem on myocardial ischemia in elderly patients with hypertension and coronary artery disease

Effects of chlorthalidone and diltiazem on myocardial ischemia in elderly patients with hypertension and coronary artery disease

Effect of Diuretics on Cardiac Arrhythmias and Left Ventricular Hypertrophy in Hypertension

Diuretic induced hyponatraemia in elderly hypertensive women

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