LETTER
Diuretics and Sudden Cardiac Death
David S. Buck, MD, MPH
15 August 1996 | Volume 125 Issue 4 | Page 347
TO THE EDITOR:
In their recent article, Hoes and colleagues [1] found that although overall mortality decreased, the rate of sudden death increased among patients receiving ß-blockers. It would be instructive to divide the ß-blocker group and determine the attributable risk for each of the ß1 selective and the nonselective ß-blocker groups. In a recent editorial, Brown [2] discusses the argument for using nonselective ß-blockade in patients without diabetes. He asserts that the population of ß2 receptors in the heart can contribute equally to arrhythmias (compared with ß1 receptors), which can result in sudden death before a patient reaches the hospital. Selective ß1 blockade also causes the ß2 receptor to be paradoxically more sensitive to adrenaline [3, 4]. Thus, using a ß1 selective ß-blocker may leave the cardiac ß2 receptor more vulnerable to arrhythmias and thus may induce sudden death. If the specific type of ß-blocker can be determined from this study, it may help us to understand for whom which drug may be most appropriate.
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Author and Article Information
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Fox Memorial Hospital, Oneonta, NY 13820
1. Hoes AW, Grobbee DE, Lubsen J, Veld AJ, van der Does E, Hofman A. Diuretics, ß-blockers, and the risk for sudden cardiac death in hypertensive patients. Ann Intern Med. 1995; 123:481-7.
2. Brown MJ. To ß block or better block? [Editorial]. BMJ. 1995; 311:701-2.
3. Hall JA, Kaumann AJ, Brown MJ. Selective ß 1-adrenoceptor blockade enhances positive inotropic responses to endogenous catecholamines mediated through ß 2-adrenoceptors in human atrial myocardium. Circ Res. 1990; 66:1610-23.
4. Hall JA, Petch MC, Brown MJ. In vivo demonstration of cardiac ß 2-adrenoceptor sensitisation by ß 1-antagonist treatment. Circ Res. 1991; 69:959-64.
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