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ARTICLE

Diuretics, ß-Blockers, and the Risk for Sudden Cardiac Death in Hypertensive Patients

Arno W. Hoes, MD, PhD; Diederick E. Grobbee, MD, PhD; Jacobus Lubsen, MD, PhD; Arie J. Man in 't Veld, MD, PhD; Emiel van der Does, MD, PhD; and Albert Hofman, MD, PhD

1 October 1995 | Volume 123 Issue 7 | Pages 481-487

Objective: To determine whether the use of non-potassium-sparing diuretics and ß-blockers is associated with an excess risk for sudden cardiac death in hypertensive patients.

Design: Case-control study.

Setting: Rotterdam, the Netherlands.

Patients: 257 case-patients who had died suddenly while receiving drug therapy for hypertension and 257 living controls also receiving drug therapy for hypertension.

Measurements: Detailed information on medication use and clinical characteristics of all case-patients and controls was collected from the files of general practitioners. Additional information on medication use was obtained from computerized pharmacy records.

Results: Patients receiving non-potassium-sparing diuretics had an increased risk for sudden cardiac death (relative risk, 1.8 [95% CI, 1.0 to 3.1]) compared with a reference group treated primarily with potassium-sparing diuretics. The corresponding relative risk for ß-blocker use was 1.7 (CI, 1.1 to 2.6). The use of non-potassium-sparing diuretics without ß-blockers was associated with a higher risk for sudden death (relative risk, 2.2 [CI, 1.1 to 4.6]) than was concomitant use of non-potassium-sparing diuretics and ß-blockers (relative risk, 1.4 [CI, 0.6 to 3.0]). The risk for sudden cardiac death among recipients of non-potassium-sparing diuretics was more pronounced in those who had been receiving the diuretic for less than 1 year and in those aged 75 years or younger.

Conclusions: The use of non-potassium-sparing diuretics and ß-blockers is associated with an increased risk for sudden cardiac death. This association may offset part of the mortality benefit of these drugs in the treatment of hypertension.

Author and Article Information

From Erasmus University Medical School, Rotterdam, the Netherlands.
Acknowledgments: The authors thank the municipal authorities in Rotterdam, especially Ronald Lockhorst and his coworkers; Dr. Cremers and his colleagues from the Rotterdam police for their essential contribution to the study; the general practitioners and pharmacists in the Rotterdam area for their enthusiastic support; Margriet Pannevis, PharmD, for obtaining information from the Rotterdam pharmacies; Andrea de Oude-Lubbers, Diane Huizer, Yolanda Bekker, Andrina Cleveringa, Sharmila Bhikha, and Dr. Sjaak Tellekamp for their valuable assistance; Marcel Eijgermans and Dick Tensen for developing the software applications; and Dr. J.P. Vandenbroucke for his helpful comments on the manuscript.
Grant Support: By grant 88.145 from the Netherlands Heart Foundation.
Requests for Reprints: Arno W. Hoes, MD, PhD, Departments of Epidemiology and Biostatistics and General Practice, Erasmus University Medical School, PO Box 1738, 3000 DR Rotterdam, the Netherlands.
Current Author Addresses: Drs. Hoes, Grobbee, and Hofman: Department of Epidemiology and Biostatistics, Erasmus University Medical School, PO Box 1738, 3000 DR Rotterdam, the Netherlands.

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