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New Trial Data on Prevention: Potassium and CV Risk in Hope
Author(s) -
Mann Johannes F. E.,
Yi QiLong,
Sleight Peter,
Dagenais Gilles R.,
Probstfield Jeff,
Gerstein Hertzel C.,
Lonn Eva M.,
Bosch Jackie,
Yusuf Salim
Publication year - 2003
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1046/j.1460-9592.2003.t01-2-00231_2.x
Subject(s) - medicine , hypokalemia , hyperkalemia , diuretic , ramipril , thiazide , hazard ratio , chlorthalidone , cardiology , stroke (engine) , endocrinology , confidence interval , blood pressure , mechanical engineering , engineering
Hypokalaemia may be hazardous. Methods: Potassium was measured in 9,297 patients in HOPE, & was <3.5 in 137. Results: The combined primary outcome (cardiovascular death, myocardial infarction, or stroke) increased with hypokalemia (22.6% vs 15.5%, p 0.023, hazard ratio 1.44). Hyperkalemia conferred no hazard Hypokalemia was more prevalent in women, in hypertensives, & with diuretics. Ramipril benefit was independent of potassium. Less patients on ramipril had hypokalaemia (p = 0.005), including those on diuretics (3.8% v 6.5%, p = 0.07). Conclusion: In high risk people hypokalemia increased the risk for cardiovascular events, while hyperkalemia did not. Ramipril was not associated with increased risk with hyperkalemia, but mitigated the diuretic induced risk of hypokalaemia; the latter may increase with increased diuretic use after ALLHAT. A diuretic/ACE‐Inhibitor combination appeared safe, & may be even more popular after the ANBP‐2 trial, which contrary to ALLHAT favoured an ACE‐I over a thiazide. HPS & ASCOT favour statins in addition.