Alterations of Serum Magnesium under Chronic Therapy with Diuretics and/or Angiotensin - Converting Enzyme Inhibitors in Hypertensive Patients

Diuretic drugs (both thiazide and loop diuretics) have been the mainstay of treatment for arterial hypertension and congestive heart failure [1,3]; however, the prolonged use of thiazide diuretics and (to a lesser extent) of loop-acting diuretics is accompanied by a variable depression of serum and tissue levels of potassium and magnesium and reduced concentrations of sodium-potassium pumps in muscle [4–6]. These diuretic - induced electrolytic disturbances have been associated with cardiac arrhythmias (ventricular ectopic activity [7,8], torsade de pointes [9] and sudden death), especially in elderly patients with hypertension, left ventricular hypertrophy, and/or congestive heart failure [9,10], although in a Editorial Review the cardiotoxicity of diuretics is thought to be the result of “much speculation and little substance” [11].