Why the study?
The risk of hyperkalemia associated with different combinations of antihypertensive therapy remained to be elucidated.
Does the combination of beta blockers, RAS inhibitors, and MRAs increase the risk of hyperkalemia compared to RAS inhibitors and thiazides in hypertensive patients?
Does the combination of beta blockers, RAS inhibitors, and MRAs increase the risk of hyperkalemia compared to RAS inhibitors and thiazides in hypertensive patients?
In hypertensive patients, the combination of beta-blockers, RAS inhibitors, and MRAs is associated with a nearly twofold increased risk of developing hyperkalemia within 90 days compared to RAS inhibitors and thiazides.
Hyperkalemia risk varies with antihypertensive combinations in registry data; hypothesis-generating and should not yet change practice.
The risk of hyperkalemia in relation to different combinations of antihypertensive therapy remains to be elucidated. In this Danish register-based study, we aimed to investigate the risk of developing hyperkalemia in relation to different combinations of antihypertensive therapy. Using incidence density matching, we matched a hyperkalemic patient to five normokalemic patients on eGFR groups, age, sex, and time between study entry and date of potassium measurement. Combination therapies were subdivided into eight groups: beta blockers (BB) + calcium channel blockers (CCB), BB + renin angiotensin system inhibitors (RASi), BB + RASi + mineralocorticoid receptor antagonists (MRA), CCB + RASi, CCB + RASi + thiazides, CCB + thiazides, RASi + thiazides, and other combinations. Multivariable conditional logistic regression was used to estimate the odds of hyperkalemia within 90 days for each of the eight antihypertensive combination therapies. A total of 793 patients with hyperkalemia were matched to 3598 normokalemic patients. In multivariable analysis, odds of developing hyperkalemia when being treated with BB + RASi + MRA was 1.95 (95% CI, 1.39-2.72) compared to RASi + thiazides (reference). CCB + thiazides (OR, 0.76 [95% CI, 0.45-1.28]) and CCB + RASi + Thiazid (OR 0.81 [95% CI, 0.51-1.28]) were among the others not significantly associated with hyperkalemia. Combinations of BB + RASi + MRA were significantly associated with an increased risk of developing hyperkalemia within 90 days of initiating treatment. Patients treated with BB + RASi + MRA within 90 days of treatment initiation, were associated with an increased hyperkalemia risk. When treating hypertensive patients with combination antihypertensive therapy, identifying and monitoring patients with a high risk of dyskalemias is a crucial goal to avoid serious adverse effects and detrimental outcomes related to dyskalemia.
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Al-Janabi et al. (2024) studied this question.
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