Fending off the Potassium Pushers

Over the past few decades the recommendations of many therapeutic enthusiasts have remained the same — namely, to prevent hypokalemia in diuretic-treated hypertensive patients by administering either potassium supplements or potassium-sparing agents. The putative rationale for this approach, however, has changed dramatically. Treatment was recommended initially simply because potassium deficiency was considered unhealthy, later because it might induce carbohydrate intolerance and hypercholesterolemia, and a few years ago because it might produce malignant arrhythmias in hypertensive patients, particularly those who sustained an acute myocardial infarction.1 Though cogent arguments have been adduced against these concerns,2 , 3 and though serious questions have been raised . . .