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MANAGEMENT OF HYPERTENSION—FURTHER SODIUM AND POTASSIUM STUDIES
Author(s) -
Priddle William W.,
Liu Sim F.,
Breithaupt David J.
Publication year - 1970
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1970.tb02840.x
Subject(s) - medicine , potassium , sodium , chlorothiazide , excretion , blood pressure , endocrinology , blood urea nitrogen , urea , regimen , essential hypertension , diuretic , chemistry , creatinine , biochemistry , organic chemistry
A bstract Since the senior author's first publication forty years ago on the relationship of sodium and potassium to hypertension, these clinical investigations have continued, and in 1958 were established at the Geriatric Study Centre in Toronto. Here, studies were started on the urinary excretion (as an index of intake) of sodium and potassium in subjects with normal blood pressure and in patients with hypertension. Some of the findings are reported in this article, including evidence for the accuracy of the laboratory values, and determination of the normal ranges for serum sodium, serum potassium, serum chloride and blood urea nitrogen in a small group of elderly persons. These studies demonstrated: 1) in persons with normal blood pressure, the urinary excretion (and presumably the intake) of sodium averaged 3.75 gm (9.375 gm NaCl) per day; 2) sodium‐restricted diets, as applied before the study, had been grossly inadequate (excretion 2 gm sodium per day); 3) the study regimen (sodium‐restricted, potassium‐rich intake plus chlorothiazide) had a beneficial effect on hypertension; 4) the potassium supplements induced a sharp rise in the urinary excretion of potassium; and 5) the lack of serious abnormalities in the levels of serum sodium, serum potassium and blood urea nitrogen indicated the safety of this regimen within the limits of this study. The authors have continued to treat hypertension with a sodium‐restricted (400 mg daily) diet, a small dosage (250 mg daily) of chlorothiazide, and potassium (4 gm daily) supplements. The findings on groups of patients treated as long as twelve years are recorded. Hypokalemia as a complication of thiazide therapy is discussed and its potential dangers emphasized. A case of recurrent hypokalemia during a three‐year period is presented to demonstrate certain clinical manifestations and the influence of hypokalemia on the electrocardiogram. The effect of the described therapeutic regimen is also detailed in a case of renovascular hypertension engrafted on essential hypertension, and in a case of hypertension treated by the Smithwick operation. The effect of therapy on morbidity and mortality from hypertension is discussed.