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Previous Volume 330:1852-1857 June 30, 1994 Number 26 Next

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ABSTRACT

Background The results of trials of the primary prevention of coronary heart disease have suggested that treating hypertension with high doses of thiazide diuretic drugs might increase the risk of sudden death from cardiac causes. In contrast, treatment with low doses of thiazide reduces the risk of coronary heart disease.

Methods To examine the association between thiazide treatment for hypertension and the occurrence of primary cardiac arrest, we conducted a population-based case-control study among enrollees of a health maintenance organization. The case patients were 114 persons with hypertension who had a primary cardiac arrest from 1977 through 1990. The control patients were a stratified random sample of 535 persons with hypertension. The patients' treatment was assessed with the use of a computerized pharmacy data base. Records of their ambulatory care were reviewed to determine other clinical characteristics.

Results The risk of primary cardiac arrest among patients receiving combined thiazide and potassium-sparing diuretic therapy was lower than that among patients treated with a thiazide without potassium-sparing therapy (odds ratio, 0.3; 95 percent confidence interval, 0.1 to 0.7). As compared with low-dose thiazide therapy (25 mg daily), moderate-dose therapy (50 mg daily) was associated with a moderate increase in risk (odds ratio, 1.7; 95 percent confidence interval, 0.7 to 4.5), and high-dose therapy (100 mg daily) was associated with a larger increase in risk (odds ratio, 3.6; 95 percent confidence interval, 1.2 to 10.8) (P value for trend, 0.02). The addition of a potassium-sparing drug to low-dose thiazide therapy was associated with a reduced risk of cardiac arrest (odds ratio, 0.4; 95 percent confidence interval, 0.1 to 1.5).

Conclusions Both the dose of thiazide drugs and the addition of potassium-sparing drugs influence the risk of primary cardiac arrest. These results may explain the differences in the effect of antihypertensive therapy on mortality from coronary heart disease in previous clinical trials.

Source Information

From the Cardiovascular Health Research Unit, the Departments of Medicine (D.S.S., B.M.P., T.D.K., K.G.W., L.C., M.K.C.), Epidemiology (D.S.S., B.M.P., T.D.K.), Biostatistics (T.E.R., X.L.), and Health Services (B.M.P., T.D.K., E.H.W.), University of Washington, Seattle; the Epicore Centre, Division of Cardiology, University of Alberta, Edmonton, Alta., Canada (P.M.R.); and the Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle (E.H.W.). Presented in part at the 33rd annual scientific meeting of the Council on Epidemiology and Prevention of the American Heart Association, Sante Fe, N.M., March 18, 1993.

Address reprint requests to Dr. Siscovick at the Cardiovascular Health Research Unit, Metropolitan Park 2 Bldg., Suite 1360, 1730 Minor Ave., Seattle, WA 98101.

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N Engl J Med 1994; 331:1235-1236, Nov 3, 1994. Correspondence

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