Annotations

that practitioners are aware of, and are able to communicate to their patients the need to take antihypertensive medica- tions continuously.

Martin F. Shapiro, M.D., M.P.H. Robert Wood Johnson Foundation Clinical Scholar

Department of Medicine University of California at Los Angeles

Los Angeles, Calif. 90024

REFERENCES

1.

2.

3.

4.

5.

6.

U.S. National Center for Health Statistics: Hypertension and hypertensive heart disease in adults. United States 1960-62, in Vital and Health Statistics, Series 11: Data from the National Health Survey, No. 13, PHS No. 1000, Washington, 1966, U.S. Government Printing Office, p. 13. McKee, P. A., Castelli, W. P., McNamara, P. M., et al.: The natural history of congestive heart failure: the Framingham study, N. Engl. J. Med. 285:1441, 1971. Kannel, W. B., Wolf, P. A., Verter, J., et al.: Epidemio- logic assessment of the role of blood pressure in stroke: the Framingham study, J.A.M.A. 214:301, 1970. Kannel, W. B.: Current status of the epidemiology of brain infarction associated with occlusive arterial disease, Stroke 2:295, 1971. Veterans Administration Cooperative Study Group on Antihypertensive Agents: Effects of treatment on morbidity in hypertension: results in patients with dia- stolic blood pressures averaging 115 through 129 mm Hg, J.A.M.A. 202:1028, 1967. Veterans Administration Cooperative Study Group on Antihypertensive Agents: Effect of treatment on morbid- ity in hypertension. II. Results in patients with diastolic blood pressure averaging 90 through 114 mm. Hg, J.A.M.A. 213:1143, 1970.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

Of the digoxin-diuretic cardiomyopathy

One of the most serious and extremely common types of cardiac disease at present is that produced by the injudicious use of digoxin and kaliuretic diuretics. As indicated previous- ly,’ it is not possible to digitalize a patient properly with the use of digoxin. This drug cannot produce a sustained “smooth” state of digitalization. When used according to the arbitrary dosages recommended by the PDR,* intoxication is quite likely to follow. Furthermore, the negative potassium balance produced by the kaliuretic diuretics frequently used in conjunction with digoxin, and also used in arbitrary dosages, will increase the patient’s sensitivity to digitalis and may even produce serious and often fatal cardiac arrhythmias. Since digoxin and kaliuretic diuretics are usually used in patients with organic heart disease, the tendency for digitalis intoxication to develop is even greater and much more serious. The use of potassium supplements in arbitrary doses may even complicate the problem further.

The “digoxin-diuretic” cardiomyopathy is a pharmacologic

*Physicians’ Desk Reference. Published by Medical Economics Company, Oradell, N. J.

540 April, 1979, Vol. 97, No. 4 0002-8703/79/040540 + 01$00.10/O 0 1979 The C. V. Mosby Co.

Wilber, J. A., and Barrow, J. G.: Hypertension-a community problem, Am. J. Med. 52:653, 1972. Apostolides, A., Hebel, J. R., McDills, M. S., et al.: High blood pressure: its care and consequences in urban centers, Int. J. Epidemiol. 3:105, 1974. Oberman, A.: Results of two stage screen in the hyper- tension detection and follow-up program (Abstr. 395), Circulation 5O:(Suppl. 3):101, 1974. Silverberg, D. S., Smith, E.S.O., Juchli, B., et al.: Use of shopping centres in screening for hypertension, Can. Med. Assoc. J. 111:769, 1974. Shapiro, M., Bleho, J., Curran, M., et al.: Problems in the control of hypertension in the community, Can. Med. Assoc. J. 118:37, 1978. U.S. National Center for Health Statistics: Vital Statis- tics of the United States, 1974, Vol II, Section 5, Life Tables, Washington, D.C., 1976, U.S. Government Print- ing Office, p. 5-14. Sackett, D. L., Haynes, R. B., Gibson, E. S., et al.: Randomized clinical trial of strategies for improving medication compliance in primary hypertension, Lancet 1: 1205, 1975. Haynes, R. B.,. Sackett, D. L., Gibson, E. S., et al.: Improvement in medication compliance in uncontrolled hypertension, Lancet 1:1265, 1976. Alderman, M. H., and Schoenbaum, E. E.: Detection and treatment of hypertension at the work site, N. Engl. J. Med. 293:65, 1975. Schoenberger, J. A., Stamler, J., Shekelle, R. B., et al: Current status of hypertension in an industrial popula- tion, J.A.M.A. 222:559, 1972. Caldwell, J. R., Cobb, S., Dowling, M. D., et al.: The dropout problem in antihypertensive treatment: a pilot study of social and emotional factors influencing a patient’s ability to follow antihypertensive treatment, J. Chronic Dis. 22:579, 1970.

cardiomyopathy of serious nature and of great frequency. This disease of the heart needs attention. It is a highly fatal disease state, frequently mistreated and unrecognized, and too frequently made more complex by mismanagement. There is no excuse to intoxicate a patient with any preparation of digitalis. Digitalis must be used in the proper amount and dosage intervals to suit each individual patient,’ just as insulin is used, and not by arbitrary dosage rules or arbitrary routine orders. It is interesting that one of the most useful and important drugs in cardiology is the one most poorly prescribed today, and it is a common cause of cardiomyopa- thy-“digoxin cardiomyopathy.”

George E. Burch, M.D. Tulane University School of Medicine

and Charity Hospital of Louisiana New Orleans, La.

REFERENCE

1. Burch, G. E.: Elegant digitalization for congestive heart failure, AM. HEART J. 83:543, 1972.