Potassium loss from blood pressure drugs may explain higher risk of adult diabetes

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Public release date: 24-Nov-2008

http://www.eurekalert.org/pub_releases/2008-11/jhmi-plf112408.php

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s Hopkins Medical Institutions

Potassium loss from blood pressure drugs may explain higher risk of

adult diabetes

s Hopkins researchers have discovered that a drop in blood potassium

levels caused by diuretics commonly prescribed for high blood pressure

could be the reason why people on those drugs are at risk for developing

type 2 diabetes. The drugs helpfully accelerate loss of fluids, but also

deplete important chemicals, including potassium, so that those who take

them are generally advised to eat bananas and other potassium-rich foods

to counteract the effect.

" Previous studies have told us that when patients take diuretic

thiazides, potassium levels drop and the risk of diabetes climbs to 50

percent, " says lead researcher Tariq Shafi, M.D., M.H.S., of the

Department of Nephrology at s Hopkins University School of Medicine.

" Now, for the first time, we think we have concrete information

connecting the dots. "

Thiazides, such as chlorthalidone, are an inexpensive and highly

effective way to treat high blood pressure and have been used widely for

decades. However, their association with diabetes has forced many

hypertension suffers to use other medications that can be several times

as expensive, says Shafi.

" This study shows us that as long as physicians monitor and regulate

potassium levels, thiazides could be used safely, saving patients

thousands of dollars a year, " says Shafi. " It could be as simple as

increasing the consumption of potassium-rich foods like bananas and

oranges and/or reducing salt intake, both of which will keep potassium

from dropping. "

Researchers examined data from 3,790 nondiabetic participants in the

Systolic Hypertension in Elderly Program (SHEP). SHEP is a randomized

clinical trial conducted between 1985 and 1991 designed to determine the

risk versus benefit of giving a certain high blood pressure medication

to people age 60 years or older.

Half of the subjects were treated with chlorthalidone and half with a

fake drug. Of the 3,790 subjects, 1,603 were men and 724 were nonwhite.

None had a history of diabetes. In the original study, potassium levels

were monitored as a safety precaution to guard against irregular

heartbeat, a condition that can result from low potassium.

The results, published online this month in the journal Hypertension,

showed that for each 0.5 milliequivalent-per-liter (MEq/L) decrease in

serum potassium, there was a 45 percent increased risk of diabetes. None

of the people in the group receiving the fake drug developed low

potassium levels. Shafi says these findings should encourage physicians

to establish a potassium baseline by checking hypertensive patients'

medical records to determine their potassium levels before prescribing

thiazides.

" We would normally look at the number only after six weeks of treatment

to make sure it was not low enough to cause heart problems. As a result,

we might not be aware that it dropped significantly from where it was

before treatment — putting the patient at risk for developing diabetes, "

says Shafi.

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Additional s Hopkins researchers who contributed to this study are

Lawrence J. Appel, M.D., M.P.H.; Edgar R. III, M.D, Ph.D.;

J. Klag, M.D., M.P.H., and Rulan S. Parekh, M.D., M.S.

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