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July 1, 1992

Diuretics, Potassium, and Ventricular Arrhythmias-Reply

Author Affiliations

University of California San Francisco

JAMA. 1992;268(1):53. doi:10.1001/jama.1992.03490010054022

In Reply.  —We agree with Drs Clarfield, Friedman, and Bergman that hypertension is an important risk factor in the elderly; in fact, some of our previous work is on this topic.1 However, the present study focused on middle-aged men because the goal was to examine findings in the Multiple Risk Factor Intervention Trial (MRFIT), which found an association between diuretic therapy (especially hydrochlorothiazide) and an increased rate of sudden death in hypertensive men 35 to 57 years of age with electrocardiographic abnormalities.2 In our study, we extended the age range to 35 to 70 years. It is of interest that the Systolic Hypertension in the Elderly Program study cited by Clarfield and colleagues restricted enrollment to individuals 60 years and above. There may be research questions [ill] most appropriate for particular age groups.In general, we agree with the thrust of Dr Papademetriou's work, which indicates that hydrochlorothiazide