Lv. Franse et al., Hypokalemia associated with diuretic use and cardiovascular events in the systolic hypertension in the elderly program, HYPERTENSIO, 35(5), 2000, pp. 1025-1030
Citations number
32
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
The treatment of hypertension with high-dose thiazide diuretics results in
potassium depletion and a limited benefit for preventing coronary events. T
he clinical relevance of hypokalemia associated with low-dose diuretics has
not been assessed. To determine whether hypokalemia that occurs with low-d
ose diuretics is associated with a reduced benefit on cardiovascular events
, we analyzed data of 4126 participants in the Systolic Hypertension in the
Elderly Program (SHEP), a 5-year randomized, placebo-controlled clinical t
rial of chlorthalidone-based treatment of isolated systolic hypertension in
older persons. After 1 year of treatment, 7.2% of the participants randomi
zed to active treatment had a serum potassium <3.5 mmol/L compared with 1%
of the participants randomized to placebo (P<0.001). During the 4 years aft
er the first annual visit, 451 participants experienced a cardiovascular ev
ent, 215 experienced a coronary event, 177 experienced stroke, and 323 died
. After adjustment for known risk factors and study drug dose, the particip
ants who received active treatment and who experienced hypokalemia had a si
milar risk of cardiovascular events, coronary events, and stroke as those r
andomized to placebo. Within the active treatment group, the risk of these
events was 51%, 55%, and 72% lower, respectively, among those who had norma
l serum potassium levels compared with those who experienced hypokalemia (P
<0.05), The participants who had hypokalemia after 1 year of treatment with
a low-dose diuretic did not experience the reduction in cardiovascular eve
nts achieved among those who did not have hypokalemia.