New Trial Data on Prevention: Potassium and CV Risk in Hope

Introduction: 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.