Hoes and associates [1] showed an increased risk for sudden cardiac death in hypertensive patients receiving non-potassium-sparing diuretics compared with a reference group, which primarily received potassium-sparing diuretics. The authors attributed this detrimental effect to the hypokalemia and hypomagnesemia produced by the non-potassium-sparing diuretics.

Given the antiarrhythmic effect of the potassium-conserving diuretic amiloride in suppressing ventricular premature contractions and runs of ventricular tachycardia [2], the difference in the rate of sudden cardiac death may be explained by a reduced risk for death from cardiac arrhythmia in the patients receiving potassium-sparing diuretics rather than by an absolute increase in the rate of deaths in the patients treated with non-potassium-sparing diuretics.

During the past several years, I have given amiloride to approximately 24 patients with mild hypertension and symptomatic, but nonrepetitive, ventricular premature contractions. Approximately half of these patients had symptomatic and objective improvement in the frequency and severity of the ventricular premature contractions with no obvious side effects. This clinical response to amiloride is roughly equivalent to the response to class I antiarrhythmic agents and is associated with considerably fewer side effects.

Given the above observations, a randomized, double-blind study comparing a potassium-sparing diuretic such as amiloride with placebo might be of value in proving the hypothesis that potassium-sparing diuretics may prolong life.