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Risk of developing hyperkalemia in patients with hypertension treated with combination antihypertensive therapy - a

Fatma Luai Mahdi Al-Janabi1, Fatme Moussa2, Sarah Taleb1

  • 1Faculty of Medicine, Aalborg University, Aalborg, Denmark.

Hypertension Research : Official Journal of the Japanese Society of Hypertension
|October 31, 2024
PubMed

Insights

The combination of beta blockers (BB), renin-angiotensin system inhibitors (RASi), and mineralocorticoid receptor antagonists (MRA) significantly increases hyperkalemia risk within 90 days. Careful monitoring for dyskalemia is crucial when initiating this antihypertensive therapy.

Area of Science:

  • Cardiology
  • Nephrology
  • Pharmacology

Background:

  • Hyperkalemia is a serious adverse effect of antihypertensive therapy.
  • The comparative risk of hyperkalemia across different antihypertensive drug combinations is not well understood.

Purpose of the Study:

  • To investigate the risk of developing hyperkalemia in relation to various combinations of antihypertensive therapy.
  • To identify specific antihypertensive combinations associated with an increased risk of hyperkalemia.

Main Methods:

  • Danish register-based study utilizing incidence density matching.
  • Matched 793 hyperkalemic patients to 3598 normokalemic patients based on eGFR, age, sex, and time.
  • Multivariable conditional logistic regression to estimate hyperkalemia odds within 90 days for eight combination therapy groups.

Main Results:

  • The combination of beta blockers (BB) + renin-angiotensin system inhibitors (RASi) + mineralocorticoid receptor antagonists (MRA) showed a significantly increased odds of hyperkalemia (OR 1.95; 95% CI, 1.39-2.72) compared to RASi + thiazides.
  • Combinations such as CCB + thiazides and CCB + RASi + thiazides were not significantly associated with hyperkalemia.
  • Initiating BB + RASi + MRA therapy was linked to a higher risk of hyperkalemia within 90 days.

Conclusions:

  • The combination of BB + RASi + MRA is associated with a significantly increased risk of hyperkalemia.
  • Identifying and monitoring patients at high risk for dyskalemia is essential when prescribing combination antihypertensive therapies.
  • This finding highlights the need for careful patient selection and monitoring to prevent adverse outcomes associated with hyperkalemia.

Keywords:
Beta blockersCalcium channel blockersMineralocorticoid receptor antagonistsPotassiumRenin angiotensin system inhibitors

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