Impact of plasma potassium normalization on short-term mortality in patients with hypertension and hypokalemia or low normal potassium.
Adolescent
Adult
Aged
Aged, 80 and over
Antihypertensive Agents
/ adverse effects
Biomarkers
/ blood
Blood Pressure
/ drug effects
Cause of Death
Denmark
Drug Therapy, Combination
Female
Humans
Hypertension
/ drug therapy
Hypokalemia
/ blood
Male
Middle Aged
Potassium
/ blood
Registries
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Young Adult
Borderline hypokalemia
Hypokalemia
Hypokalemia correction
Low potassium.
Mortality
Journal
BMC cardiovascular disorders
ISSN: 1471-2261
Titre abrégé: BMC Cardiovasc Disord
Pays: England
ID NLM: 100968539
Informations de publication
Date de publication:
24 08 2020
24 08 2020
Historique:
received:
16
04
2020
accepted:
04
08
2020
entrez:
26
8
2020
pubmed:
26
8
2020
medline:
12
1
2021
Statut:
epublish
Résumé
Hypokalemia is common in patients treated with antihypertensive drugs, but the impact of correcting hypokalemia is insufficiently studied. We examined the consequences of hypokalemia and borderline hypokalemia correction in patients with hypertension. We identified 8976 patients with hypertension and plasma potassium concentrations ≤3.7 mmol/L within 100 days from combination antihypertensive therapy initiation. The first measurement between 6 and 100 days after the episode with potassium ≤3.7 mmol/L was retained. We investigated all-cause and cardiovascular mortality within 60-days from the second potassium measurement using Cox regression. Mortality was examined for seven predefined potassium intervals derived from the second measurement: 1.5-2.9 mmol/L (n = 271), 3.0-3.4 mmol/L (n = 1341), 3.5-3.7 (n = 1982) mmol/L, 3.8-4.0 mmol/L (n = 2398, reference), 4.1-4.6 mmol/L (n = 2498), 4.7-5.0 mmol/L (n = 352) and 5.1-7.1 mmol/L (n = 134). Multivariable analysis showed that potassium concentrations 1.5-2.9 mmol/L, 3.0-3.4 mmol/L, 4.7-5.0 mmol/L and 5.1-7.1 mmol/L were associated with increased all-cause mortality (HR 2.39, 95% CI 1.66-3.43; HR 1.36, 95% CI 1.04-1.78; HR 2.36, 95% CI 1.68-3.30 and HR 2.62, 95% CI 1.73-3.98, respectively). Potassium levels <3.0 and > 4.6 mmol/L were associated with increased cardiovascular mortality. The adjusted standardized 60-day mortality risks in the seven strata were: 11.7% (95% CI 8.3-15.0%), 7.1% (95% CI 5.8-8.5%), 6.4% (95% CI 5.3-7.5%), 5.4% (4.5-6.3%), 6.3% (5.4-7.2%), 11.6% (95% CI 8.7-14.6%) and 12.6% (95% CI 8.2-16.9%), respectively. Persistent hypokalemia was frequent and associated with increased all-cause and cardiovascular mortality. Increase in potassium to levels > 4.6 mmol/L in patients with initial hypokalemia or low normal potassium was associated with increased all-cause and cardiovascular mortality.
Sections du résumé
BACKGROUND
Hypokalemia is common in patients treated with antihypertensive drugs, but the impact of correcting hypokalemia is insufficiently studied. We examined the consequences of hypokalemia and borderline hypokalemia correction in patients with hypertension.
METHODS
We identified 8976 patients with hypertension and plasma potassium concentrations ≤3.7 mmol/L within 100 days from combination antihypertensive therapy initiation. The first measurement between 6 and 100 days after the episode with potassium ≤3.7 mmol/L was retained. We investigated all-cause and cardiovascular mortality within 60-days from the second potassium measurement using Cox regression. Mortality was examined for seven predefined potassium intervals derived from the second measurement: 1.5-2.9 mmol/L (n = 271), 3.0-3.4 mmol/L (n = 1341), 3.5-3.7 (n = 1982) mmol/L, 3.8-4.0 mmol/L (n = 2398, reference), 4.1-4.6 mmol/L (n = 2498), 4.7-5.0 mmol/L (n = 352) and 5.1-7.1 mmol/L (n = 134).
RESULTS
Multivariable analysis showed that potassium concentrations 1.5-2.9 mmol/L, 3.0-3.4 mmol/L, 4.7-5.0 mmol/L and 5.1-7.1 mmol/L were associated with increased all-cause mortality (HR 2.39, 95% CI 1.66-3.43; HR 1.36, 95% CI 1.04-1.78; HR 2.36, 95% CI 1.68-3.30 and HR 2.62, 95% CI 1.73-3.98, respectively). Potassium levels <3.0 and > 4.6 mmol/L were associated with increased cardiovascular mortality. The adjusted standardized 60-day mortality risks in the seven strata were: 11.7% (95% CI 8.3-15.0%), 7.1% (95% CI 5.8-8.5%), 6.4% (95% CI 5.3-7.5%), 5.4% (4.5-6.3%), 6.3% (5.4-7.2%), 11.6% (95% CI 8.7-14.6%) and 12.6% (95% CI 8.2-16.9%), respectively.
CONCLUSIONS
Persistent hypokalemia was frequent and associated with increased all-cause and cardiovascular mortality. Increase in potassium to levels > 4.6 mmol/L in patients with initial hypokalemia or low normal potassium was associated with increased all-cause and cardiovascular mortality.
Identifiants
pubmed: 32838735
doi: 10.1186/s12872-020-01654-3
pii: 10.1186/s12872-020-01654-3
pmc: PMC7446172
doi:
Substances chimiques
Antihypertensive Agents
0
Biomarkers
0
Potassium
RWP5GA015D
Types de publication
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
386Références
Eur Heart J. 2017 Jan 7;38(2):104-112
pubmed: 28158516
Crit Care. 2019 Dec 19;23(1):415
pubmed: 31856891
Adv Med. 2019 Sep 24;2019:4919707
pubmed: 31663004
Arch Intern Med. 2000 Sep 11;160(16):2429-36
pubmed: 10979053
Scand J Public Health. 2011 Jul;39(7 Suppl):12-6
pubmed: 21898916
Am J Med. 2018 Mar;131(3):318.e9-318.e19
pubmed: 29024624
BMJ. 2011 Jan 31;342:d124
pubmed: 21282258
J Clin Hypertens (Greenwich). 2011 Sep;13(9):639-43
pubmed: 21896142
Drug Intell Clin Pharm. 1986 May;20(5):370-1
pubmed: 3709348
Eur Heart J Cardiovasc Pharmacother. 2020 Jul 1;6(3):137-144
pubmed: 31263883
P T. 2015 Mar;40(3):185-90
pubmed: 25798039
Hypertension. 2012 May;59(5):926-33
pubmed: 22431578
Expert Opin Pharmacother. 2014 Apr;15(5):605-21
pubmed: 24456327
Ann Intern Med. 2009 May 5;150(9):604-12
pubmed: 19414839
Eur Heart J. 2017 Oct 7;38(38):2890-2896
pubmed: 29019614
J Hypertens. 2014 Oct;32(10):2092-7; discussion 2097
pubmed: 25105457
Scand J Public Health. 2011 Jul;39(7 Suppl):22-5
pubmed: 21775345
Eur Heart J Cardiovasc Pharmacother. 2015 Oct;1(4):245-51
pubmed: 27418967