Non-Potassium Sparing Diuretics and Risk of Sudden Death

A systematic review 1 including 31 studies (10 of which were controlled trials) was abstracted in DARE. Trials that included hypertensive patients and reported sudden cardiac death as a separate endpoint were included.

The incidence of sudden cardiac death per 100 patient years reported in individual studies ranged from 0.4 to 6.7 in the groups treated with non-potassium-sparing diuretics, and from 0 to 12.5 in the comparison groups. In 9 of the 10 studies, point estimate of the incidence of sudden cardiac death in the group treated with non-potassium sparing diuretics was similar to or higher than that in the comparison group. No pooled estimate was given. In the one study which favoured the treatment group, the incidence rate for sudden cardiac death was 0.5 (95% CI 0.2 to 1.8).

Comment: The quality of evidence is downgraded by inconsistency (heterogeneity) and by imprecise results (few patients and wide confidence intervals).

The following decision support rules contain links to this evidence summary:

• Hypertension and hypokalaemia http://www.ebmeds.org/ebmeds/ebmeds_home.asp?mode=scripts&submode=view&id=scr00508&country=UK

References

• Hoes AW, Grobbee DE, Peet TM, Lubsen J. Do non-potassium-sparing diuretics increase the risk of sudden cardiac death in hypertensive patients? Recent evidence. Drugs 1994 May;47(5):711-33. [PubMed] [DARE]