[Cardiovascular risk of diuretics in the treatment of arterial hypertension].

During the last 25 years, diuretics have been widely used with safety and efficacy in the treatment of arterial hypertension and edematous states. Nevertheless, recent intervention trials failed to show a significant decrease in mortality of ischemic heart disease in hypertensive patients given pharmacological treatment. These results led to reassessment of cardiovascular risks of antihypertensive drugs per se and particularly diuretics. Diuretics have a kaliuretic effect and long-term administration decreases serum potassium levels by 0.3 to 0.6 mmol/l. The long-term consequences of hypokaliemia are not well defined. The incidence of hypokaliema-induced ventricular arrhythmias has been studied with exercise or continuous ambulatory electrocardiograms but results are still conflicting. Patients with digitalis treatment, or with preexisting ischemic heart disease or left ventricular hypertrophy may be at high risk for developing ventricular arrhythmias. Glucose intolerance is related in part to the degree of hypokalemia and its incidence decreases with lower dosage of diuretics. Lipid disturbances including hypertriglyceridemia and increase in LDL-cholesterol have not been found to be persistent in long-term administration (1 yr or more) of diuretics.