Effects of potassium supplementation by salt on arterial blood pressure and insulin resistance in hypertensive obese patients on diuretic therapy
Keywords:
potassium chloride, diuretics, obesity, arterial blood pressure, insulin resistanceAbstract
Objective
The objectives of the present study were to evaluate the effects of oral potassium supplementation, associated with a hypocaloric diet and aerobic exercises, on plasma potassium levels, blood pressure and insulin resistance, in centrally obese, not well controlled hypertensive patients on diuretic therapy; waist to hip ratio >0.85 in women, and >0.95 in men; systolic blood pressure >140mmHg and <160mmHg and/or diastolic blood pressure >90mmHg and <105mmHg.
Methods
This was a prospective double-blind randomized study including 22 patients divided in 2 groups: sodium chloride n=10, and potassium chloride n=12. For 12 weeks, each group received cooking salt containing, either 100% sodium chloride, or 50% sodium chloride and 50% potassium chloride. All patients were submitted to a hypocaloric diet and advised to increase their physical activity; a 40-minute walk three times a week. Before and after the study period, all patients were submitted to determinations of body mass index, body composition, waist circumference, sodium and potassium urinary excretions, sodium and potassium serum levels, 24h ambulatory blood pressure monitoring, oral glucose tolerance test with serum insulin measurements at fasting and 120 minutes after glucose load, and serum lipid profile.
Results
In both groups, no changes were observed in serum sodium and potassium levels, in blood glucose and insulin levels, insulin resistance indexes and serum lipid profile. The body mass index decreased similarly in both groups; 3.5±2.0% in sodium Chloride, and 2.7±3.2% in Potassium Chloride, as well as 24 h systolic ambulatory blood pressure monitoring mean; from 134.7 ±14.8 to 130.2±12.6mmHg (p<0.05) in group sodium chloride, and from 128.2±7.4 to 122.9±5.7mmHg (p<0.05) in potassium, and 24h diastolic ambulatory blood pressure monitoring from 84.4±10.2 to 81.4 ± 8.9mmHg in sodium chloride, and from 84.0±5.7 to 79.5±3.9mmHg (p<0.05) in group potassium (p<0.05). Changes in 24h systolic ambulatory blood pressure monitoring correlated with changes in the waist circumference, but not with changes in bory mass index when all patients were analyzed together. Serum lipid profile, blood glucose levels and insulin resistance indexes did not differ between groups and did not change during the study.
Conclusion
Weight reduction induced by life style changes, promotes reductions in blood pressure, which are proportional
to reductions in abdominal fat. Potassium supplementation through cooking salt was insufficient to avoid
serum potassium falling during diuretic therapy and did not show any additional beneficial effect on blood
pressure or insulin resistance in hypertensive patients with central obesity.
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References
Ribeiro AB, Kohlmann Jr O, Marson O, Zanella MT, Ramos OL. Hypertension: A major public health problem in Brazil. Drugs. 1988; 35(Suppl 1):1-5.
The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure (JNC VI). Arch Intern Med. 1997; 157(21):2413-46.
Tharkur V, Robert R, Reisin E. Obesity, hypertension, and the heart. Am J Med Sci. 2001; 321(4):242-8.
Plavnick FL, Rodrigues CIS, Zanella MT, Ribeiro AB. Hypokalemia, glucose intolerance, and hyperinsulinemia during diuretic therapy. Hypertension. 1992; 19(2 Suppl 2):II-26-9.
Blaustein MP, Hamlyn JM. Pathogenesis of essential hypertension. Hypertension. 1991; 18(5 Suppl 3):III-184-95.
Franssila-Kallunki A, Rissanen A, Ekstrand A, Ollus A, Groop L. Effects of weight loss on substrate oxidation, energy expenditure, and insulin sensitivity in obese individuals. Am J Clin Nutr. 1992; 55(2):356-61.
The Trials of Hypertension Prevention, Phase II (TOHP II) Effects of weight loss and sodium reduction intervention on blood pressure and hypertension incidence in overweight people with high-normal blood pressure. Arch Intern Med. 1997; 157(6):657-67.
Stevens VJ, Obarzanec KE, Look NR, Lee IM, Appel LT, Smith West D, et al. Long-term weight loss and changes in blood pressure: results of the trials of hypertension prevention, phase II. Ann Intern Med. 2001; 134(1):1-11.
He J, Whelton PK, Appel LJ, Charleston J, Klag M. Long-term effects of weight loss and dietary sodium reduction on incidence of hypertension. Hypertension. 2000; 35(2):544-9.
Luft FC, Weinberger MH. Sodium sensitivity and resistance of blood pressure: The role of the kidney and the renin-aldosterone axis. Kidney Int Suppl. 1987; 32(2):234-41.
Graudal AG, Galloe AM, Garred, P. Effects of sodium restrition on blood pressure, renin, aldosterone, catecholamines, cholesterol and triglycerides. JAMA. 1998; 279(17):1383-91.
Whelton PK. Effects of oral potassium on blood pressure. Meta-analysis of randomized control clinical trials. JAMA. 1997; 277(20):1624-32
Whelton PK. Potassium in preventing and treating high pressure. Sem Nephrol. 1999; 19(5):494-9.
Fujita T, Katsuyuki A. Hemodynamic and endocrine changes associated with potassium supplementation in sodium-loaded hypertensives. Hypertension. 1984; 6(2):184-92.
McCabe RD, Michael AB, Kumud S, David BY. Potassium inhibits free radicals formation. Hypertension. 1994; 24(1):77-82.
Gennari FJ. Hypocalemia. N Engl J Med. 1998; 339(7):451-8.
Lotaif LAD, Ribeiro AB. Efeito da suplementação de potássio através do sal de cozinha na hipertensão arterial primária, leve a moderada. J Bras Nefrol. 1995; 17:214-8.
Pratley RE, Hagberg JM, Dengel DR, Rogus EM, Muller DC, Goldberg AP. Aerobic exercise training- -induced reduction in abdominal fat and glucose- -stimulated insulin responses in middle-aged and older men. J Am Geriatric Soc. 2000; 48(9): 1055-61.
Soma VR, Koivisto VA, Deibert D, Felig P, DeFronzo RA, Increased insulin sensitivity and insulin binding to monocytes after physical training. N Engl J Med. 1979; 301(22):1200-4.
Pedersen O, Beeck-Nielsen H, Heding L. Increased insulin receptors after exercise in patients with insulin-dependent diabetes mellitus. N Engl J Med. 1980; 302(16):886-92.
Mikines KJ, Sonne B, Trinier B, Galbo H. Effects of acute exercise and detraining on insulin action in trained men. J Appl Physiol. 1989; 66(2):704-11.
Conlin PR, Chow D, Miller ER 3rd, Svetkey LR, Lin PH, Harsha DW, et al. The effect of dietary patterns on blood pressure control in hypertensive patients: Results from the dietary approaches to stop hypertension (DASH) Trial. Am J Hypertens. 2000; 13(9):949-55.
Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistence and b-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985; 28(7):412-9.
Grandi AM, et al. Insulin sensitivity in obese normotensive adults: influence of family history of hypertension. Int J Obes Relat Metab Disord. 1998; 22(9):910-4.
Zanella MT, Baptista M, Costa CH, Kohlmann NE, Kohlmann Junior O, Ribeiro AB. Comparative effects of captopril and chlorthalidone on glucose tolerance and insulin levels in essential hypertensives. Arq Bras Cardiol. 1996; 67(1): 47-52.
Faria AN, Ribeiro FFF, Lerário DDG, Kolmann N, Ferreira SRG, Zanella MT. Effects of sibutramine on the treatment of obesity in patients with hypertension. Arq Bras Cardiol. 2002; 78:176-80.
Bakris G, Calhoun D, Egan B, Helmann C, Dolker M, Kingma I. Orlistat improves blood pressure control in obese subjects with treated but inadequade controlled hypertension. J Hypertens. 2002; 20(11):2257-67.
Wylie-Rossett J, Wassertheil-Smaller S, Blaufox MD, Davis BR, Langford HG, Oberman A, et al. Trial of antihypertensive intervention and management: greater efficacy with weight reduction than with a sodium potassium intervention. J Am Diet Assoc. 1993; 93(4):408-15.
Burt VL, Artler JA, Higgins M, Horan MJ, Labarthe D, Whelton P, et al. Trends in the prevalence, awareness, treatment and control of hypertension in the adult US population. Hypertension. 1995; 26(1):60-9.
Miller R, Erlinger TP, Young DR, Jehn M, Charleston J, Rhodes D, et al. Results of diet, exercise and weight loss intervention trial (DEW_IT). Hypertension. 2002; 40(5):612-8.
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