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O. Bryan Holland, LaVon Kuhnert, Jeanne Pollard, Marci Pddia, Ron J. Anderson, Gunnar Blomqvist, Ventricular Ectopic Activity With Diuretic Therapy, American Journal of Hypertension, Volume 1, Issue 4_Pt_1, October 1988, Pages 380–385, https://doi.org/10.1093/ajh/1.4.380
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Abstract
The arrhythmogenic potential of diuretic-induced hypokalemia in patients with uncomplicated hypertension has been controversial Thirty-two hypertensive patients with previous diuretic-induced hypokalemia, normal 24-hour ambulatory ECG monitoring, and normal exercise testing were treated with 100 mg hydrochlorothiazide (HCTZ) daily (Group 1) to induce hypokalemia or with a combination of HCTZ with amiloride (Group 2) to attempt to maintain plasma potassium levels in the normal range during diuretic therapy. Those Group 1 patients (Group 1A) with increased ventricular ectopic activity (VEA) during HCTZ therapy were subsequently potassium-repleted with amiloride and with supplemental potassium chloride to evaluate the effect of these treatments on VEA. One Group 1 patient died suddenly after 12 days of HCTZ therapy. Autopsy findings suggested an arrhythmic death. Six Group 1 patients who had increased VEA with HCTZ treatment had reductions in VEA with amiloride or supplemental potassium chloride. Group 2 patients did not have a significant increase in VEA. Thus, diuretic therapy appears to cause VEA primarily by electrolyte changes that are induced. Am J Hypertens 1988;1:380-385
