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Thiazide therapy is not a cause of arrhythmia in patients with systemic hypertension
V Papademetriou1, J F Burris, A Notargiacomo
1Georgetown University Medical Center, Washington, DC.
Insights
Hydrochlorothiazide treatment for hypertension did not increase ventricular ectopy, even with lowered potassium levels. Patients with left ventricular hypertrophy had more arrhythmias but were not worsened by diuretic therapy.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Systemic hypertension is a common condition requiring management.
- Diuretics like hydrochlorothiazide are frequently prescribed for hypertension.
- Potential side effects, such as hypokalemia and cardiac arrhythmias, warrant investigation.
Purpose of the Study:
- To investigate the effect of hydrochlorothiazide on ventricular ectopy in patients with uncomplicated hypertension.
- To determine if diuretic-induced hypokalemia correlates with increased ventricular arrhythmias.
- To assess the impact of left ventricular hypertrophy on ventricular ectopy during diuretic therapy.
Main Methods:
- 48-hour electrocardiographic monitoring was performed before and after 4 weeks of hydrochlorothiazide treatment (100 mg daily) in 44 hypertensive patients.
- Plasma potassium levels were measured pre- and post-treatment.
- Ventricular ectopy was quantified, including premature ventricular contractions, couplets, and ventricular tachycardia episodes.
Main Results:
- Hydrochlorothiazide treatment led to a significant decrease in plasma potassium levels (from 4.07 to 3.36 mmol/L).
- No significant changes were observed in the average number of premature ventricular contractions, couplets, or ventricular tachycardia episodes.
- Neither diuretic therapy nor hypokalemia (potassium ≤ 3.4 mmol/L) increased ventricular ectopy; patients with left ventricular hypertrophy had more baseline ectopy, which was not adversely affected by the diuretic.
Conclusions:
- Diuretic therapy with hydrochlorothiazide does not appear to increase ventricular ectopy in patients with uncomplicated hypertension.
- Diuretic-induced hypokalemia did not correlate with increased ventricular arrhythmias in this study.
- Left ventricular hypertrophy may be associated with a higher burden of ventricular ectopy, but this is not exacerbated by hydrochlorothiazide treatment.
Abstract:
Forty-four patients with uncomplicated systemic hypertension underwent 48-hour electrocardiographic monitoring before and after four weeks of treatment with hydrochlorothiazide, 100 mg daily. Plasma potassium concentration decreased from 4.07 +/- 0.26 mmol/L (4.07 +/- 0.26 mEq/L) to 3.36 +/- 0.44 mmol/L (3.36 +/- 0.44 mEq/L). The average number of premature ventricular contractions, couplets, or ventricular tachycardia episodes did not change significantly. Twenty patients had more than minimal ventricular ectopy (class 2 to 5) before and 17 after diuretic therapy. Further analysis revealed that following diuretic therapy, neither patients with plasma potassium levels of 3.4 mmol/L or less (less than or equal to 3.4 mEq/L) nor patients with left ventricular hypertrophy had increased ectopy as compared with baseline. At baseline, patients with left ventricular hypertrophy had more arrhythmias than patients without. We conclude that the results of this study provide no evidence that diuretic therapy or diuretic-induced hypokalemia results in increased ventricular ectopy, and that patients with left ventricular hypertrophy may have more ventricular ectopy than patients without, but these arrhythmias are not adversely effected by diuretic therapy.