Antihypertensive therapy and its effects on potassium homeostasis

The role of potassium in cardiovascular disease and the importance of preserving potassium balance have emerged as clinical hot points, particularly as they relate to cardioprotective and renoprotective therapies that secondarily promote potassium retention. Antihypertensive medications that most commonly influence serum potassium levels and/or total body potassium include beta blockers and potassium-wasting and potassium-sparing diuretics as well as angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Uncertainty exists as to the best way to monitor potassium levels when any of these drug therapies are used, particularly in the setting of chronic kidney disease and/or heart failure. Guidelines for the monitoring of serum potassium levels in the setting of antihypertensive therapy are at best makeshift and often drawn from the know-how of the treating physician.