HYPOKALEMIA BLUNTS LEFT VENTRICULAR MASS REGRESSION IN HYPERTENSIVE PATIENTS DURING LOSARTAN- OR ATENOLOL-BASED TREATMENT: THE LIFE ECHO-SUBSTUDY: 9D.06

Background: It has been reported that hypokalemia (HypoK) is associated with persistent ECG left ventricular (LV) hypertrophy in treated hypertensive patients. The aim of the present study was to assess the impact of HypoK on echocardiographic LV mass regression during aggressive antihypertensive treatment. Methods: We analyzed data from 863 patients in the LIFE echo substudy (age 66±7 years, 41% women) with available serum K + levels. Patients were dichotomized according to presence of HypoK (i.e. <3.90mmol/L, lowest quartile). LV mass regression after one year of treatment was compared among groups. Results: Patients with HypoK had similar mean age and gender distribution to patients with normal K + (all p=ns), but higher systolic and diastolic blood pressure (BP) and heart rate (all p<0.05). After one year, similar reduction among groups in both systolic and diastolic BP (p=ns) was found. In multivariate analysis controlling for differences in age, gender, baseline LV mass, hydroclorothiazide use before or during the study, baseline BP, and BP change, patients with HypoK had a significantly lower regression of LV mass as compared to the normal K + group (p<0.001). Furthermore, while in patients randomized to Losartan (n=434) reduction in LV mass was not significantly different in the absence or presence of HypoK (p=ns), in the Atenolol group HypoK was associated with a nearly 60% lower LV mass reduction (Figure ; p<0.001). Conclusions: Despite similar blood pressure reduction with treatment, patients with HypoK have a lower LV mass regression. While Losartan is able to offset the negative impact of HypoK, its presence markedly affects LV mass reduction on Atenolol-based therapy. Figure. Left ventricular mass reduction after one year of anti-hypertensive treatment according to serum K + levels and treatment arm.