Lower urinary potassium excretion was associated with higher risk of cerebro-cardiovascular- and renal events in patients with hypertension under treatment with anti-hypertensive drugs

  • Shinya Minatoguchi
    Corresponding author at: Heart Failure Center, Gifu Municipal Hospital, 7–1 Kashimachou, Gifu 500–8513, Japan
    Heart Failure Center, Gifu Municipal Hospital, Gifu, Japan.
    Department of Circulatory and Respiratory Advanced Medicine, Gifu University Graduate School of Medicine, Gifu, Japan.
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  • on behalf ofNOBUNAGA investigators
    Author Footnotes
    1 Members who participated in the NOBUNAGA study (Natrium effect On Blood pressure Under Natrium intake Assessment in Gifu Area) study
  • Author Footnotes
    1 Members who participated in the NOBUNAGA study (Natrium effect On Blood pressure Under Natrium intake Assessment in Gifu Area) study
Published:August 18, 2022DOI:


      • Lower urinary K excretion was associated with higher risk of cerebro-cardiovascular and renal (CCR) events.
      • Lower urinary K excretion was associated with higher risk of all-cause mortality.
      • There was no association between urinary NaCl excretion and CCR events.
      • There was no association between urinary NaCl excretion and all-cause mortality.



      Hypertension is one of the risk factors for cerebro-cardiovascular and renal (CCR) diseases. High blood pressure is affected by the amount of salt (NaCl) and potassium (K) intake. There are many studies reporting the relationship between urinary sodium or potassium excretion and CCR events or all-cause mortality in general populations. Thus, it is necessary to investigate the relationship between urinary NaCl or K excretion and CCR events or all-cause mortality in hypertensive patients under control with anti-hypertensive drugs.


      A prospective, multi-center cohort study was performed in 3210 hypertensives under treatment with anti-hypertensive drugs for 5 years. The primary outcome was the CCR events, and the secondary outcome was all-cause mortality. A time-dependent Cox proportional hazards regression analysis was performed to assess the association between outcomes and urinary NaCl and K excretion, blood pressure, or heart rate.


      During the follow-up period, 61 CCR events and 110 all-cause deaths occurred. There was no association between urinary NaCl excretion and CCR events or all-cause mortality. Lower urinary K excretion and higher Na/K ratio were associated with higher risk of CCR events or all-cause mortality. The CCR events were not associated with systolic, diastolic blood pressure, or heart rate.


      Lower urinary K excretion was associated with higher risk of CCR events or all-cause mortality in hypertensive patients under treatment with anti-hypertensive drugs.

      Graphical abstract


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