SERUM ELECTROLYTE LEVELS IN HEART FAILURE PATIENTS WITH A HYPERTENSION HISTORY

Background: Knowing the description of serum electrolytes in those with a history of hypertension and congestive heart failure is critical. Purpose: The purpose of this study is to look into the estimation of serum electrolytes, the correlation between serum electrolytes (sodium (Na⁺), potassium (K⁺), chlorine (Cl^-)) levels with blood pressure, and the demographic characteristics of heart failure patients with a history of hypertension. Method: A retrospective design was used in this study, which used progress records (e.g., participant demographic data, medical history, and clinical laboratory tests such as serum electrolytes and blood chemistry) from patients with hypertension and Heart Failure (HF) who were hospitalized. Result: The present study established no correlation between serum electrolyte levels and blood pressure. The highest of Na⁺ levels were 169 mEq/L, K⁺ 6.4 mEq/L, and Cl^- 119 mEq/L. Most participants had the habit of not smoking (87 people, 79.8%) and not consuming alcohol (91 people, 83.5%). Demographic characteristics such as gender, smoking habits, and alcohol consumption had no significant impact on serum electrolyte levels, except for a history of alcohol consumption on sodium levels, which had a significant effect (p-value = 0.014). Furthermore, an absence of correlation was observed between demographic factors and blood pressure. Conclusion: A lack of relationship between serum electrolyte levels and blood pressure. Similarly, demographic characteristics were not correlated with blood pressure. HF patients with a history of hypertension show normal serum electrolyte levels, but a significant relationship between alcohol consumption habits and sodium levels was found.

Introduction

Heart failure (HF) is a common disease with a significant risk of morbidity and mortality worldwide(Zhang et al., 2018). During the study period, 15.084 women and 15.822 men died from heart failure, women and men were equally likely to die from heart failure(Taylor et al., 2021). HF patients’ outcomes are known to be predicted by their serum sodium levels(Tanai & Frantz, 2015). A consensus meeting was held by the Heart Failure Association on the topic of physiological monitoring of the complex multi-morbid HF patient, with one important aspect being monitoring of the related features of congestion status, renal function, and electrolyte levels, particularly potassium(Rossignol et al., 2019). Electrolyte imbalances are common in heart failure. Diuretics, renal impairment, neurohormonal activation, and a combination of these factors can all cause them.

Sodium (Na⁺) and potassium (K⁺) are the most commonly tampered with electrolytes(Verbrugge et al., 2015). Chloride (Cl^-) is also harmed(Ter Maaten et al., 2016). Na⁺, K⁺, and Cl^-are interested in the clinical course of HF because their changes may necessitate intervention or adaptation of HF therapies, and they appear to be related to prognosis(Kammerlander, 2019). Patients whose serum sodium levels fall below 125 mEq/L solely due to heart failure are usually nearing the end of their lives. Patients with heart failure with this hyponatremia level are also prone to hyperkalemia. In advanced cardiac disease, distal sodium and water delivery are so low that potassium excretion (primarily dependent on distal potassium secretion) falls below the intake level(Sterns & Gottlieb, 2024).

The segmentation regression model identified a turning point value of serum sodium levels (137.5 mmol/L) for all-cause death. Lower serum sodium levels (<137.5 mmol/L) were linked to a higher risk of all-cause mortality across 30, 90, 365 days, and 4 years, according to the fully adjusted cox proportional hazard model(Peng et al., 2022). Advanced heart failure patients often experience hyponatremia, the most prevalent electrolyte disorder. Hyponatremia is characterized by a serum sodium concentration below 136 mEq/L(Adrogué, 2017). Hyponatremia is a key clinical concern during and after hospitalization for patients with heart failure, as it is associated with poor short- and long-term outcomes(Şorodoc et al., 2023). Another study found no correlation between discharge hyponatremia and post-discharge morbidity or mortality, indicating that hyponatremia is not the sole cause of poor HF outcomes(Omar et al., 2017). The study revealed that Atrial Fibrillation (AF) in HF was more common in outpatients with Heart Failure with Reduced Ejection Fraction (HFrEF) and hyponatremia than in those with HFrEF and normonatremia. These findings further indicate that hyponatremia is independently linked to the development of AF(Cavusoglu et al., 2019). Cl^-is a better predictor of outcomes than sodium in HF, and the current debate over the beneficial versus detrimental effects of salt restriction in HF patients may be related, in part, to its impact on chloride homeostasis. Changes in plasma volume, vasopressin secretion, and the Renin Angiotensin Aldosterone Systems (RAAS) that occur with worsening HF are thought to be primarily mediated by serum chloride rather than serum sodium levels(Kataoka, 2017).

Decreased serum chloride concentrations were independently associated with increased all-cause mortality, Cardiovascular Disease (CVD) mortality, cancer mortality, and respiratory disease mortality(Hou et al., 2023), while another study found that chloride, Blood Urea, and Nitrogen (BUN) were inversely linked with diastolic blood pressure(Ríos-González et al., 2024). Both chloride and sodium are powerful ions found in extracellular fluid. Several studies have claimed that serum sodium abnormalities predict poorer outcomes in acute or chronic HF patients ((Cuthbert et al., 2018);(Grodin et al., 2015);(Rossignol et al., 2019);(Zandijk et al., 2021)). However, almost none of them have considered chloride levels in their analyses. Serum electrolytes, measured routinely, have been suggested as a marker of (de)congestion and associated with cardiovascular disease. The most major risk facto is Hypertension (HTN), while other risk factors include advanced age, female gender, and diabetes(Ziaeian & Fonarow, 2016). As a result, knowing the description of serum electrolytes in those with a history of HTN and congestive heart failure is critical. This study aims to look into the estimation of serum electrolytes, the correlation between serum electrolytes (Na⁺, K⁺, and Cl^-) and blood pressure, and the demographic characteristics of heart failure patients with a history of hypertension.

Material and Method

Material

A retrospective design was used in this study, which used progress records (e.g., participant demographic data, medical history, and clinical laboratory tests such as serum electrolytes and blood chemistry) from patients with hypertension and heart failure who were hospitalized. The procedure for taking samples and test materials is by the electrolyte test (electrolyte panel). Blood is drawn from a vein in the arm using a tiny needle. After inserting the needle, a small amount of blood is collected into a test tube or vial. When the needle is inserted or removed, the patient may experience a minor sting. This operation normally takes less than five minutes. The test materials (Na⁺, K⁺, and Cl^-serum) were examined using an electrolyte analyzer with an Ion-emitting or Selective Electrode (ISE). This tool contains four electrodes, namely Na