CORRESPONDENCE: LETTER TO THE EDITOR
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Pantelis A. Sarafidis, MD, PhD and
George L. Bakris, MD*
* University of Chicago Pritzker School of Medicine, Hypertensive Diseases Unit, 5841 South Maryland Avenue, Chicago, Illinois 60637 (Email: gbakris{at}gmail.com).
We thank Drs. Kapoor and Kapoor for their interest in our paper (1) and are well aware of information that potassium supplementation ameliorates hypertension. In fact, this concept is well known and was described more than a quarter century ago (2,3). In most human studies, patients who were evaluated did not have resistant hypertension as defined by the current definition. In most clinical studies, potassium supplementation, although reducing blood pressure (BP), provides an average reduction of only 3 to 6 mm Hg in systolic pressure. Although this reduction is meaningful, such a reduction in BP would not be sufficient to supplant antihypertensive medications in resistant hypertensive patients. Moreover, we do specifically mention the importance of potassium levels when considering BP treatment, but because most patients with resistant hypertension have chronic kidney disease, hypokalemia is generally not as common a problem as hyperkalemia.
Finally, we had a case referral that was presented at the American Heart Association in 2007 for resistant hypertension. She was taking 3 full-dose antihypertensive medications with serum potassium of 3.2 mEq/l and was consuming a daily diet that contained 35 g of sodium, based on a 24-h urine result. After placing her on a 3-g sodium diet and administering amiloride and short-term potassium supplementation (i.e., 2 weeks) along with increasing her fruit and vegetable intake for 1 month, we were able to stop all of her antihypertensive medications. At this time, her serum potassium was corrected to 4.1 mEq/l, and her daily sodium intake was 2.8 g/day. Her blood pressure was reduced from 144/86 mm Hg on triple therapy to 128/82 mm Hg on no medications and a high-potassium, low-sodium diet. The lesson of this case is not just that potassium intake is important but that the balance of sodium, potassium, and probably magnesium are important for maintaining arterial homeostasis (4).
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References
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1. Sarafidis PA, Bakris GL. Resistant hypertension: an overview of evaluation and treatment J Am Coll Cardiol 2008;52:1749-1757.[Abstract/Free Full Text]2. MacGregor GA. Sodium and potassium intake and blood pressure Hypertension 1983;5:III79-III84.[Medline] 3. MacGregor GA, Smith SJ, Markandu ND, Banks RA, Sagnella GA. Moderate potassium supplementation in essential hypertension Lancet 1982;2:567-570.[Web of Science][Medline] 4. Resnick LM, Barbagallo M, Dominguez LJ, Veniero JM, Nicholson JP, Gupta RK. Relation of cellular potassium to other mineral ions in hypertension and diabetes Hypertension 2001;38:709-712.[Abstract/Free Full Text]
Related Article
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Blood Pressure Reduction With Potassium Supplementation
- Roger Kapoor and John R. Kapoor
J. Am. Coll. Cardiol. 2009 53: 1164.
[Full Text]
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