European Journal of Cardiovascular Medicine

Background: Hypokalemia associated with hypertension is an important clinical clue to secondary hypertension, particularly primary hyperaldosteronism. Early identification of the underlying cause facilitates targeted treatment and reduces cardiovascular morbidity. The present study was undertaken to evaluate the clinical presentation, laboratory profile, and etiological spectrum of patients presenting with hypokalemia associated with hypertension. Methods: This hospital-based observational cross-sectional study included 80 adult patients with hypertension and serum potassium levels <3.5 mEq/L recruited over 18 months at a tertiary care teaching hospital. Demographic characteristics, clinical features, blood pressure, laboratory investigations, hormonal profile, electrocardiographic findings, and final diagnoses were recorded. Data was analyzed using SPSS version 22.0, with p<0.05 considered statistically significant. Results: The majority of patients were aged 41–60 years (51.3%) with male predominance (57.5%). Fatigue (70.0%), muscle weakness (61.3%), and headache (55.0%) were the most frequent presenting symptoms. Stage 2 hypertension was most common (41; 51.3%) and mild hypokalemia was predominant (39; 48.7%). Mean serum potassium was 2.91±0.42 mEq/L, and 76.3% of patients had spot urine potassium-to-creatinine ratio ≥15 mEq/g. The mean aldosterone-to-renin ratio was elevated (31.6±12.8). U waves were the most common electrocardiographic abnormality (45.0%). Primary hyperaldosteronism was the leading diagnosis (42.5%), followed by renovascular hypertension (22.5%). Patients with primary hyperaldosteronism had significantly higher mean aldosterone–renin ratio (42.8±10.6) than other groups (p<0.001). Conclusion: Hypokalemia in hypertensive patients frequently indicates an underlying secondary cause, particularly primary hyperaldosteronism, and may be associated with significant target-organ damage. Early clinical, biochemical, hormonal, and ECG evaluation is essential for timely diagnosis and prevention of cardiovascular and renal complications.