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Diuretics and Coronary Heart Disease-Reply
Anders Helgeland, MD;
Ingvar Hjermann, MD;
Ingar Holme, PhD;
Per G. Lund-Larsen, MD;
Paul Leren, MD
Oslo University Medical School Ullevaal Hospital
JAMA. 1985;253(8):1123.
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In Reply.—
We could not agree more with Drs Moser and Gifford. The reported adverse effect of diuretics for the treatment of mild hypertension in patients with certain minor ECG abnormalities needs to be viewed with caution.
We also agree that all adequately designed hypertension studies using diuretics have shown a reduction in morbidity and mortality from pressure complications such as stroke, but not from CHD, and that is just the point. The Hypertension Detection and Follow-up Program study1 that is mentioned cannot help to solve this question because of its lack of an untreated control group.
In the Australian study2 which we believe is the best designed randomized trial in mild hypertension, no beneficial effect of thiazides on the incidence of acute myocardial infarction could be demonstrated: 33 cases of acute myocardial infection were observed in each group.
Vague indications of a possible adverse effect on CHD
. . . [Full Text PDF of this Article]
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