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July 1985

Diuretics, Hypokalemia, and Ventricular Ectopy: The Controversy Continues

Author Affiliations

Veterans Administration Medical Center 5901 E Seventh St Long Beach, CA 90822

Arch Intern Med. 1985;145(7):1185-1187. doi:10.1001/archinte.1985.00360070055006

New medical diagnostic techniques have led to improved and constantly changing approaches to such medical problems as sudden death and cardiomyopathy. The opportunity to communicate new ideas and findings in medical journals has facilitated these improvements but at the same time has generated controversy in medical management and therapy. In the November 1984 issue of the Archives, Madias et al1 rekindled the controversy of the clinical significance of diuretic-induced hypokalemia.

Because over 50 million Americans have hypertension and at least half of them will receive diuretic therapy, the issues raised about treatment have broad and far-reaching implications.2 There are many advocates for β-blockers as initial therapy because of misgivings about thiazide diuretics and their potential for causing hypokalemia and other metabolic-electrolyte abnormalities (hyperglycemia, hyperuricemia, hypomagnesemia, and calcium and lipoprotein abnormalities).3,4 In addition, recent large intervention trials such as the Multiple Risk Factor Intervention Trial (MRFIT)5 and