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Letters |1 December 1995

Do Diuretics Cause Heart Disease?

Edward D. Freis, MD

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  • Veterans Affairs Medical Center; Washington, DC 20422
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IN RESPONSE:
Most of the evidence presented by Drs. Shivkumar and Narins concerns potassium depletion produced by dietary restriction or by low potassium perfusates of tissues rather than depletion produced by administration of diuretics. Results obtained by such methods may not be relevant to hypokalemia produced by thiazide diuretics. For example, I am not aware of any definite evidence that either short- or long-term administration of diuretics leads to damaged renal function or structure or that either leads to muscle weakness or paralysis.
The reference to the possibility that diuretic-induced hypokalemia may cause a reduction in phase-4 depolarization is inappropriate. They refer to a study in which action potentials were recorded from Purkinje fibers of the pig while the area was perfused with Krebs solution containing less than 1 mmol/L of potassium. This process resulted in reduction of phase 4 depolarization. This experiment is not relevant because the potassium level was far lower than would occur during administration of thiazides.
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Freis ED. Do Diuretics Cause Heart Disease?. Ann Intern Med. ;123:891–892. doi: 10.7326/0003-4819-123-11-199512010-00018

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Published: Ann Intern Med. 1995;123(11):891-892.

DOI: 10.7326/0003-4819-123-11-199512010-00018

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