A Man With Hypokalemia, Sleep Apnea, and Resistant Hypertension

Minh Chung; Eric Warren, DO; Darshan Rola; Brian Zacharias; Jennifer Broyles, MD


July 20, 2022

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.


A 59-year-old man with a past history of hypertension, hypokalemia, type 2 diabetes, hyperlipidemia, asthma, sleep apnea, and gastroesophageal reflux disease (GERD) presents for follow-up of his chronic conditions. During the two previous visits, his systolic blood pressure ranged between the 150s and the 170s, when measured in a sitting position. The patient reports that his blood pressure has always been elevated, and that the systolic pressure was in the high 130s at home.

He currently takes lisinopril 20 mg twice a day, hydrochlorothiazide 25 mg every morning, and extended-release nifedipine 90 mg once a day for uncontrolled hypertension. He takes extended-release potassium chloride 20 mEq twice a day for hypokalemia and metformin 500 mg twice a day for type 2 diabetes. Despite taking three antihypertensives from three different classes (an angiotensin-converting enzyme [ACE] inhibitor, a thiazide diuretic, and a calcium channel blocker), he continues to be hypertensive and to have hypokalemia, which requires potassium supplementation.

The patient does not report any associated symptoms of chest pain, shortness of breath, fatigue, palpitations, headaches, muscle weakness, or changes in vision. His family history is not significant for cardiovascular disease (CVD), hyperlipidemia, or diabetes. He has no history of tobacco use, illicit drug use, or alcohol consumption.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.