Key result
Antihypertensive therapy links to a ~1% prevalence of hypokalemia, driven most often by indapamide.
Why the study?
Drug-induced hypokalemia is often asymptomatic but can increase cardiovascular risk, prompting this assessment of hypokalemia prevalence and laboratory monitoring in patients treated for arterial hypertension with indapamide or hydrochlorothiazide.
Cross-Sectional (n=1,835)
Yes
Despite a low overall prevalence of severe hypokalemia (1.2%), mild hypokalemia (<4.0 mmol/L) is common (13.1%) in hypertensive patients on thiazide/thiazide-like diuretics, highlighting the need for better laboratory monitoring in primary care.
Answers are grounded in this paper and cite their sources.
Mild hypokalemia common on thiazides may warrant monitoring vigilance; leaves open indapamide-specific risks in hypertension.
Objective: Drug-induced hypokalemia (prevalence 7-56%) is often asymptomatic, but it can increase cardiovascular risk. This study aimed to determine the prevalence of hypokalemia and the proportion of laboratory findings in patients treated for arterial hypertension (AH) with indapamide or hydrochlorothiazide in family medicine practices (FMPs). Design and method: Within four FMPs in Zagreb, Croatia, all patients with AH (ICD-10: I10–I15) at the time of the study (January–August 2025) were selected. The prescribed and ordered antihypertensive therapy (AHt), the duration of AH, and basic laboratory parameters, along with the date of the last results, were recorded. Patients taking furosemide/torsemide, insulin, or on ongoing oncological treatment were excluded. Student's t-test and ratios (Statistica v.12.0) were used for statistical analysis. Results: 1835 subjects (927 female) aged 67.2±20.1 years and with a known duration of AH of 10.4±5.9 years were included. Laboratory findings were found in 1047 subjects (57.1%) during the last year; 82 findings were older than five years (4.5%), and 326 subjects had no findings in their records (17.8%). Potassium was missing in 177 subjects (9.6%), and eGFR was not present in 199 (10.8%). 575 subjects were treated with indapamide (31.3%), 274 with hydrochlorothiazide (14.9%), 1457 with ACEi/sartans (79.8%), 1009 with calcium channel blocker (54.9%), 550 with beta blocker (29.9%), and 46 with MRA (2.5%). 1760 subjects (95.8%) regularly ordered therapy. Men had lower potassium (4.31 vs. 4.41mmol/L, p<0.001) and higher eGFR than women (82.5 vs. 79.7 ml/min/1.73m2, p<0.001). Potassium <3.5mmol/L were present in 16 subjects (1.2%) and <4.0 in 174 (13.1%), most often with indapamide (68.7% and 53.4%). Potassium levels 4.0-5.0 were present in 1036 subjects (77.8%), and >5 mmol/L in 106 subjects (8.0%), mostly without any diuretic within AHt. Conclusions: The prevalence of hypokalemia in people with AH was only 1.2%. However, potassium levels below 4 mmol/L were found in 13.1% patients, most often treated with indapamide, while a quarter of them had no potassium findings recorded. It is necessary to improve the monitoring of laboratory parameters in patients with AH according to guidelines and to adjust AHt to reduce the prevalence of hypokalemia and cardiovascular risk.
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Jug et al. (2026) conducted a cross-sectional in Arterial hypertension (n=1,835). Thiazide and thiazide-like diuretics (indapamide or hydrochlorothiazide) was evaluated on Prevalence of hypokalemia (potassium <3.5 mmol/L). In patients treated for arterial hypertension, the prevalence of hypokalemia (<3.5 mmol/L) was 1.2%, while potassium levels below 4.0 mmol/L occurred in 13.1%, most often with indapamide.
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