Role of Potassium in Preventive Cardiovascular Medicine

by Young, David B.

• ISBN13: 9780792373766
• ISBN10: 0792373766
• Format: Hardcover
• Copyright: 2001-07-31
• Publisher: Kluwer Academic Pub

Summary

Role of Potassium in Preventive Cardiovascular Medicine: Information related to this question has accumulated for nearly a hundred years, from work in cellular physiology, experimental studies in animals, clinical trials, and from population and epidemiological investigations. Because of the importance of integration of this diverse body of information, the most significant findings are brought together in this book. This body of information provides emphatic support for the importance of high dietary potassium intake as a means of reducing the risk of cardiovascular diseases, as it provides abundant evidence that potassium depletion has significant, deleterious influences that increase the risk of hypertension, atherosclerosis, heart failure, and stroke. At this time we have the results and data required to strongly recommend dietary modification to increase potassium intake. But making the recommendation will only be the first step; convincing the population to undertake the change in eating patterns will be challenging, and will require concerted actions by government, the medical community, and the food and beverage industries. The outcome promises to be well worth the investment. 'This book is an excellent source of current information on the many roles of potassium in cardiovascular disease. It succinctly mixes basic physiology and clinical aspects in a manner that will make it of great value to both researchers and clinicians.' Norman M. Kaplan, M.D., Professor of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX

Table of Contents

Foreword	xiii
John H. Laragh, Jr.
Introduction	1	(8)
SECTION I: POTASSIUM REGULATION
Physiology of Potassium Regulation	9	(34)
Potassium Transport Along the Nephron	10	(4)
Regulation of Potassium Distribution	14	(3)
Hormonal and Non-Hormonal Factors that May Affect Potassium Excretion and Distribution	17	(8)
Long-Term Regulation of Potassium: Importance of Aldosterone and Extracellular Potassium Concentration	25	(6)
Systems Analyses of Potassium Regulation	31	(10)
Summary	41	(2)
Interactions Between Cardiovascular Pharmacotherapeutics and Potassium Regulation	43	(8)
Diuretics	44	(3)
Angiotensin Converting Enzyme Inhibitors and Angiotensin II Receptor Antagonists	47	(1)
Mineralocorticoid Antagonists	48	(2)
Beta Adrenergic Receptor Antagonists	50	(1)
Summary	50	(1)
POTASSIUM DEPLETION AND HYPOKALEMIA	51	(20)
Symptoms	52	(3)
Etiology	55	(7)
Diagnosis	62	(1)
Treatment	63	(4)
Summary	67	(4)
SECTION II: CARDIOVASCULAR RESPONSES TO CHANGES IN POTASSIUM
Vascular Cell Responses to Changes in Potassium Concentration	71	(16)
Cellular Basis of Atherosclerotic Lesion Formation	72	(3)
Cellular Basis of Restenosis Lesion Formation	75	(1)
Reduction in Platelet Sensitivity in Response to Increases in Potassium Concentration	75	(2)
Oxygen Free Radical Formation is Inhibited by Elevation of Potassium Concentration	77	(1)
Inhibition of Vascular Smooth Muscle Proliferation Cell by Elevation of Potassium Concentration	78	(4)
Inhibition of Vascular Smooth Muscle Migration by Elevation of Potassium Concentration	82	(4)
Summary: Proposed Mechanisms of Cardiovascular Protective Effect of Dietary Potassium	86	(1)
Inhibition of Thrombosis and Stroke by Elevation of Potassium	87	(14)
Inhibition of Experimental Coronary and Carotid Artery Thrombosis by Elevation of Potassium Concentration	88	(3)
Protection Against Stroke in the Stroke-Prone Rat Model by High Dietary Potassium Intake	91	(2)
Evidence from Population Based Studies of Protection Against Stroke by High Dietary Potassium Intake	93	(5)
Summary	98	(3)
Inhibition by Potassium of Arteriosclerosis and Atherosclerotic Lesion Formation	101	(10)
Etiology of Lesion Formation	102	(1)
Potential Mechanisms of Protection against Lesion Development by Elevation of Potassium Concentration	102	(1)
Inhibition by Dietary Potassium of Coronary Arteriosclerotic Lesion Formation in a Rabbit Model	103	(2)
Evidence from Population Based Studies of Protection by Potassium against Development of Arteriosclerotic Disease	105	(3)
Summary	108	(3)
Neointimal Proliferation and Restenosis Following Angioplasty are Inhibited by Dietary Potassium Supplementation in Experimental Models	111	(12)
Etiology of Restenosis	111	(2)
Inhibition of Neointimal Lesion Formation Following Angioplasty in Animal Models by Elevation of Dietary Potassium Intake	113	(9)
Summary	122	(1)
Evidence of an Inverse Relationship Between Dietary Potassium Intake and Blood Pressure	123	(32)
Blood Pressure Regulation and the Etiology of Hypertension	124	(3)
Alterations in Blood Pressure Control Functions of the Kidney Associated with Changes in Potassium Intake and Plasma Potassium Concentration	127	(7)
Reduction in Blood Pressure by Elevation of Potassium Intake in Experimental Hypertension	134	(1)
Reduction in Blood Pressure in Hypertensive Patients by Potassium Supplementation	135	(7)
Blood Pressure Reduction by Elevation of Potassium Intake and Other Dietary Modifications -- the DASH Trial	142	(5)
Epidemiological Evidence that High Dietary Potassium Intake Protects Against Hypertension	147	(7)
Summary	154	(1)
Arrhythmogenic Significance of Hypokalemia	155	(14)
Potassium's Impact on Electrophysiological Properties of Myocardial Cells	155	(4)
Electrocardiographic Alterations with Changes in Potassium Concentration	159	(1)
Clinical Data Relating Hypokalemia to Arrhythmias	159	(8)
Summary	167	(2)
Moderate Potassium Depletion Impairs Cardiac Mechanical Function	169	(20)
Chronic Hypokalemia and Left Ventricular Function in Dogs	170	(9)
Cardiac Function Responses to Moderate Potassium Depletion in Normal Volunteers	179	(7)
Summary	186	(3)
Conclusion	189	(12)
Summary	190	(3)
Recommendations	193	(5)
Conclusions	198	(3)
References	201	(14)
Index	215