Clinical Implications

Abstract

HomeHypertensionVol. 75, No. 4Clinical Implications Free AccessIn BriefPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessIn BriefPDF/EPUBClinical Implications Originally published11 Mar 2020https://doi.org/10.1161/HYPERTENSIONAHA.120.14732Hypertension. 2020;75:893is related toRisk of Developing Hypokalemia in Patients With Hypertension Treated With Combination Antihypertensive TherapyPrevalence of Hypokalemia and Primary Aldosteronism in 5100 Patients Referred to a Tertiary Hypertension UnitBlood Pressure Variability and the Risk of DementiaBlood Pressure Variability and Dementia (page 982)Download figureDownload PowerPointDementia is a major health concern and the prevalence rises with the aging of the population. Recently, raised blood pressure variability (BPV) has emerged as a novel risk factor for development and progression of cognitive decline. However, evidence for the association of BPV and incidence of dementia is limited. In this nationwide retrospective cohort study, we therefore aimed to investigate the association between visit-to-visit BPV and the incidence of dementia in 7 844 814 participants without a history of any dementia who underwent ≥3 health examinations from 2005 to 2012 in the Korean National Health Insurance System cohort. Dementia was directly associated with higher BPV, both systolic and diastolic. In particular, having both higher systolic and diastolic BPV had additive effects on the risk of all-cause dementia, Alzheimer dementia, and vascular dementia. These associations were consistent across variability indices and independent of various factors, including use of antihypertensive drugs, blood pressure control status, or absolute blood pressure change during follow-up. These observations suggest the possibility of a causal relationship between BPV and development of dementia. They highlight that antihypertensive treatment which attenuates long-term BPV may offer benefits in reducing dementia risk in high-risk groups such as older people. Further research is warranted to examine whether reducing variability of blood pressure parameters decreases adverse outcomes.Hypokalemia: Combination Antihypertensive Therapy (page 966)Download figureDownload PowerPointManagement of arterial hypertension implies both lifestyle changes and medical treatment. In most cases, nonpharmacological strategies are not sufficient to achieve optimal blood pressure control and ≈70% of patients with high blood pressure achieve the therapeutic goal of <140/90 mm Hg with combination therapy only. Hypokalemia and hyperkalemia are common side effects of the drugs used to treat hypertension. Awareness of the risk factors associated with potassium disturbances is important to identify patients at risk. We found that the combination of thiazides with calcium channel blockers, renin-angiotensin system inhibitors, or β-blockers was strongly associated with increased hypokalemia risk within 90 days of treatment initiation, despite potassium supplementation in many patients. We recommend close monitoring of potassium status in patients prescribed thiazide diuretics. Maybe use of thiazide-like diuretics instead of thiazides can reduce the risk of low potassium concentrations, as they have a lower natriuretic effect.Hypokalemia and Primary Aldosteronism in Patients with Hypertension (page 1025)Download figureDownload PowerPointPrimary aldosteronism (PA) used to be considered a rare disorder associated with severe hypertension and spontaneous hypokalemia. The widespread screening of patients with hypertension using the aldosterone-to-renin-ratio increased the detection of milder forms and, as a consequence, normokalemic hypertension was uncovered as the most common phenotype of PA, with hypokalemia detected in around a third of cases. The Endocrine Society guideline recommends screening for PA in patients with moderate and severe hypertension, drug-resistant hypertension, and in cases of adrenal incidentaloma. The prevalence of PA is well defined in these patient cohorts. The guideline also highly recommends screening hypertensive patients with spontaneous or diuretic-induced hypokalemia. Surprisingly, the prevalence of PA in patients with hypokalemic hypertension is unknown; the guideline recommendation is based on expert opinion and pathophysiological considerations. In our retrospective observational study, we present the first report of the prevalence of PA in patients with hypokalemia referred to a tertiary hypertension unit. The prevalence of PA gradually increased with decreasing serum potassium concentrations reaching 9 of every 10 patients with spontaneous hypokalemia and serum potassium <2.5 mmol/L. Patients with hypertension and hypokalemia displayed a worse cardiovascular risk profile than patients with normokalemia, independent of PA diagnosis. With our findings, we confirm that hypokalemia strongly suggests PA and support the guideline recommendation to screen hypokalemic patients with hypertension, although normokalemia does not exclude the diagnosis. Previous Back to top Next FiguresReferencesRelatedDetailsCited By (2020) Worldwide Increase in Diagnosis of Hypertension in Children, AAP Grand Rounds, 10.1542/gr.43-5-59, 43:5, (59-59), Online publication date: 1-May-2020. Related articlesRisk of Developing Hypokalemia in Patients With Hypertension Treated With Combination Antihypertensive TherapyMaria Lukács Krogager, et al. Hypertension. 2020;75:966-972Prevalence of Hypokalemia and Primary Aldosteronism in 5100 Patients Referred to a Tertiary Hypertension UnitJacopo Burrello, et al. Hypertension. 2020;75:1025-1033Blood Pressure Variability and the Risk of DementiaJung Eun Yoo, et al. Hypertension. 2020;75:982-990 April 2020Vol 75, Issue 4 Advertisement Article InformationMetrics © 2020 American Heart Association, Inc.https://doi.org/10.1161/HYPERTENSIONAHA.120.14732PMID: 32160097 Originally publishedMarch 11, 2020 PDF download Advertisement