Critique of the clinical importance of diurectic-induced hypokalemia and elevated cholesterol level.

Abstract

One of the disappointing conclusions of the antihypertensive drug trials is that, while most morbid events were prevented by treatment, the incidence of death from coronary heart disease (CHD) was not significantly reduced. As originally emphasized in the Veterans Administration trial 1 and in most subsequent trials, treatment has not resulted in a significant reduction in myocardial infarction (MI) and sudden death. Various hypotheses have been advanced to explain the lack of benefit in the prevention of complications of coronary heart disease, including the following: (1) critical reduction of blood flow in the coronary arteries by lowering blood pressure too far with antihypertensive drugs; (2) initiation of treatment too late in patients with extensive coronary artery atherosclerosis; (3) failure to reduce other risk factors, such as diet and cigarette smoking; (4) inadequate length of follow-up to detect differences; and (5) use of drugs that may increase the risk of CHD