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Effects of angiotensin II receptor blockers on serum potassium level and hyperkalemia risk: retrospective

Sakae Fukushima1, Manami Oishi2, Hiroya Aso2

  • 1Pharmacy, Nihon University Itabashi Hospital, Itabashi-ku, Tokyo, Japan fukushima.sakae@nihon-u.ac.jp.

European Journal of Hospital Pharmacy : Science and Practice
|June 29, 2021
PubMed

Insights

Angiotensin II receptor blockers (ARBs) can increase serum potassium levels, but the risk of hyperkalaemia appears similar to calcium channel blockers (CCBs). Continuous monitoring of potassium is recommended during ARB treatment.

Area of Science:

  • Cardiology
  • Pharmacology
  • Nephrology

Background:

  • Angiotensin II receptor blockers (ARBs) are known to increase hyperkalaemia risk.
  • Few studies have used active comparators to assess this risk.
  • Calcium channel blockers (CCBs) serve as a relevant comparator in clinical practice.

Purpose of the Study:

  • To compare the effect of ARB treatment versus CCB treatment on serum potassium levels.
  • To evaluate the risk of hyperkalaemia in patients receiving ARBs compared to CCBs.
  • To assess ARB and CCB effects in a real-world clinical setting.

Main Methods:

  • Retrospective study at a Japanese general hospital.
  • Identified ARB-naive (819 patients) and CCB-naive (1015 patients) users.
  • Compared serum potassium levels pre- and post-ARB treatment and estimated hyperkalaemia risk (hazard ratios).

Main Results:

  • ARB treatment led to a statistically significant increase in serum potassium levels (0.05 mEq/L, p=0.02) compared to CCB treatment.
  • No significant association was found between ARB use and hyperkalaemia (adjusted HR 0.91, p=0.82).

Conclusions:

  • ARB initiation necessitates continuous serum potassium monitoring due to potential increases.
  • The hyperkalaemia risk associated with ARBs appears comparable to that of CCBs.
  • Clinical practice should consider potassium monitoring protocols for ARB users.
Abstract

Keywords:
clinical medicinedrug monitoringdrug-related side effects and adverse reactionshospitalpharmacy administrationpharmacy service

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