Antihypertensive Medications and the Prevalence of Hyperkalemia in a Large Health System

Alex R. Chang, Yingying Sang, Julia Leddy, Taher Yahya, H. L. Kirchner, Lesley A. Inker, Kunihiro Matsushita, Shoshana Ballew, Josef Coresh, Morgan Grams

Research output: Contribution to journalArticle

Abstract

Little is known about the frequency and patterns of hyperkalemia in clinical settings. We evaluated the association between baseline antihypertensive medications that may affect potassium levels (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, β-blockers, loop/thiazide diuretics, and potassium-sparing diuretics) and hyperkalemia, defined by potassium >5 mEq/L and >5.5 mEq/L, over a 3-year time period in 194 456 outpatients in the Geisinger Health System, as well as actions taken after an episode of hyperkalemia. The proportions of patients with 0, 5 mEq/L and >5.5 mEq/L occurred in 10.8% and 2.3% of all patients over the 3-year period; among patients with ≥4 measurements per year, corresponding values were 39.4% and 14.6%. Most cases of hyperkalemia occurred only once during follow-up. The antihypertensive medication class most strongly associated with hyperkalemia was angiotensin-converting enzyme inhibitors. Among patients with a measurement of potassium >5.5 mEq/L, only 24% were seen by a nephrologist and 5.2% were seen by a dietician during the 3-year period. Short-term actions after a potassium measurement >5.5 mEq/L included emergency room visit (3.1% within 7 days), remeasurement of potassium (44.3% with 14 days), and change in a potassium-altering medication (26.4% within 60 days). The most common medication changes were discontinuation/dose reduction of an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker or potassium-sparing diuretic, which occurred in 29.1% and 49.6% of people taking these medications, respectively. In conclusion, hyperkalemia is common. Future research may enable optimal renin–angiotensin–aldosterone system inhibitor use with improved management of hyperkalemia.

Original languageEnglish (US)
JournalHypertension
DOIs
StateAccepted/In press - Apr 11 2016

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Hyperkalemia
Antihypertensive Agents
Potassium
Health
Potassium Sparing Diuretics
Angiotensin-Converting Enzyme Inhibitors
Angiotensin Receptor Antagonists
Sodium Potassium Chloride Symporter Inhibitors
Sodium Chloride Symporter Inhibitors
Nutritionists
Hospital Emergency Service
Outpatients

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Antihypertensive Medications and the Prevalence of Hyperkalemia in a Large Health System. / Chang, Alex R.; Sang, Yingying; Leddy, Julia; Yahya, Taher; Kirchner, H. L.; Inker, Lesley A.; Matsushita, Kunihiro; Ballew, Shoshana; Coresh, Josef; Grams, Morgan.

In: Hypertension, 11.04.2016.

Research output: Contribution to journalArticle

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abstract = "Little is known about the frequency and patterns of hyperkalemia in clinical settings. We evaluated the association between baseline antihypertensive medications that may affect potassium levels (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, β-blockers, loop/thiazide diuretics, and potassium-sparing diuretics) and hyperkalemia, defined by potassium >5 mEq/L and >5.5 mEq/L, over a 3-year time period in 194 456 outpatients in the Geisinger Health System, as well as actions taken after an episode of hyperkalemia. The proportions of patients with 0, 5 mEq/L and >5.5 mEq/L occurred in 10.8{\%} and 2.3{\%} of all patients over the 3-year period; among patients with ≥4 measurements per year, corresponding values were 39.4{\%} and 14.6{\%}. Most cases of hyperkalemia occurred only once during follow-up. The antihypertensive medication class most strongly associated with hyperkalemia was angiotensin-converting enzyme inhibitors. Among patients with a measurement of potassium >5.5 mEq/L, only 24{\%} were seen by a nephrologist and 5.2{\%} were seen by a dietician during the 3-year period. Short-term actions after a potassium measurement >5.5 mEq/L included emergency room visit (3.1{\%} within 7 days), remeasurement of potassium (44.3{\%} with 14 days), and change in a potassium-altering medication (26.4{\%} within 60 days). The most common medication changes were discontinuation/dose reduction of an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker or potassium-sparing diuretic, which occurred in 29.1{\%} and 49.6{\%} of people taking these medications, respectively. In conclusion, hyperkalemia is common. Future research may enable optimal renin–angiotensin–aldosterone system inhibitor use with improved management of hyperkalemia.",
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