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Critique of the Clinical Importance of Diuretic-Induced Hypokalemia and Elevated Cholesterol Levels

Arch Intern Med. 1990;150(12):2600-2603. doi:10.1001/archinte.1990.00390230136031.
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To the Editor.—In commenting on Dr Edward Freis' article, "Critique of the Clinical Importance of Diuretic Induced Hypokalemia and Elevated Cholesterol Levels,"1 Dr Kaplan states that "diuretic induced hypercholesterolemia may persist, as shown in the Multiple Risk Factor Intervention Trial cohort and in smaller long-term studies." The smaller long-term study referred to by Dr Kaplan is that of Middeke and coworkers, 2 which initially involved only 33 patients; at the end of 42 months, only 7 subjects remained. As noted in Table 1, cholesterol levels did increase from 5.98 to (Continued on p 2603.)

Table 1.—Serum Lipoproteins on Hydrochlorothiazide Subsets of Subjects— HAPPHY Study* Hydrochlorothiazide, Mo 0 (33) 42 (7) Cholesterol, mmol/L (mg/dL) HDL-cholesterol, mmol/L (mg/dL) LDL-cholesterol, mmol/L (mg/dL) Triglycerides, mmol/L (mg/dL) 5.98 (231)±43 1.1 (43)±13 4.03 (156)±38 1.78 (158)±74 7.22 (279)±76 1.18 (46)±13 4.88 (189)±63 2.48 (220)±116 *From Middeke and coworkers.1 HAPPHY indicates Heart Attack Primary Prevention


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