The role of potassium in the pathogenesis and treatment of hypertension

Abstract

A 38-year-old black male was referred for the evaluation of recentonset hypertension. He had formerly been a professional athlete, who had been normotensive 6 years earlier. Since retiring from athletics, he had gained 60 lbs and had performed little exercise. He had smoked one to one and one-half packs of cigarettes daily for 10 years, and he drank 3 to 5 beers per day. He had a strong family history of cardiovascular disease: his mother died at age 42 of hypertension and a cerebrovascular accident, and his father died at age 55 with hypertension and a myocardial infarction. Physical examination revealed a healthy black male, whose weight was estimated to be 25% above the upper limits of his ideal body weight. The blood pressure was 150—158/98—104 mm Hg in both arms. The pulse rate was 60—66 beats/mm on multiple determinations over one month. Funduscopic examination revealed mild arteriolar narrowing and arteriovenous crossing changes. jugular venous pressure was estimated to be 4—6 cm H20. No carotid bruits were heard. Lung examination was normal. The PMI was normal, as were 51 and S2. An S4 was present. No murmurs, clicks, or rubs were present. Abdominal examination disclosed no visceromegaly, bruits, or masses. Rectal examination was unremarkable. The pulses in the extremities were normal, and there was no pulse lag between the arms and legs. No edema was present. Neurologic examination was normal. Laboratory studies revealed: sodium, 142 mEq/liter; potassium, 3.3