Top

American Journal of Cardiovascular Drugs

Published in:

01-08-2012 | Original Research Article

Comparison of Hyperkalemic Risk in Hospitalized Patients Treated with Different Angiotensin Receptor Blockers

A Retrospective Cohort Study Using a Korean Clinical Research Database

Authors: Inwhee Park, Seung Soo Sheen, Hong-Seok Lim, Dukyong Yoon, Man Young Park, Suk-Hyang Lee, Gyu-Tae Shin, Heungsoo Kim, Dr Rae Woong Park

Published in: American Journal of Cardiovascular Drugs | Issue 4/2012

Abstract

Background and Aim

Clinical use of angiotensin II type 1 receptor antagonists (angiotensin receptor blockers [ARBs]) is associated with hyperkalemia as an adverse drug reaction. Although it has significant clinical implications, the incidence and relative risks of hyperkalemia with various ARBs have not yet been fully evaluated. The purpose of this study was to determine the risk of hyperkalemic events in hospitalized patients treated with different ARBs and to compare the risk among them.

Methods

We constructed a retrospective cohort composed of hospitalized adult patients who took ARBs in a single tertiary teaching hospital between April 2004 and March 2010. We estimated the incidence of hyperkalemia (serum potassium level >5.5 mEq/L) with various ARBs, and then compared the risk between them using a multivariate Cox proportional hazard model based on age, sex, Charlson co-morbidity score, baseline serum potassium, underlying diseases, and concomitant drugs.

Results

We identified 6992 evaluable intervals from 5449 patients treated with one of the seven ARBs during hospitalization over the 71-month study period with 2521.6 patient-months. We found 381 hyperkalemic events (5.4%) during the study period and an overall event rate of 15.1/100 patient-months. Moderate to fatal hyperkalemia was relatively rare (>6.0 mEq/L, 2.1% [moderate]; >6.5 mEq/L, 0.9% [severe]; >7.0 mEq/L, 0.3% [fatal]). After adjustment for covariates, telmisartan showed a lower risk of hyperkalemia (hazard ratio 0.67; 95% confidence interval 0.51, 0.89) compared with all other ARBs.

Conclusion

The risk of hyperkalemic events in hospitalized patients treated with different ARBs was defined. Telmisartan showed a relatively lower hyperkalemic risk profile in hospitalized patients compared with other ARBs.

Dahlof B, Devereux RB, Kjeldsen SE, et al. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002 Mar 23; 359 (9311): 995–1003PubMedCrossRef

Lewis EJ, Hunsicker LG, Clarke WR, et al. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 2001 Sep 20; 345 (12): 851–60PubMedCrossRef

Schrader J, Luders S, Kulschewski A, et al. Morbidity and Mortality After Stroke, Eprosartan Compared with Nitrendipine for Secondary Prevention: principal results of a prospective randomized controlled study (MOSES). Stroke 2005 Jun; 36 (6): 1218–26PubMedCrossRef

Burnier M, Brunner HR. Angiotensin II receptor antagonists. Lancet 2000 Feb 19; 355 (9204): 637–45PubMedCrossRef

Thompson CA. New angiotensin-receptor blocker approved by FDA. Am J Health Syst Pharm 2011 Apr 1; 68 (7): 550

Shier DN, Kusano E, Stoner GD, et al. Production of renin, angiotensin II, and aldosterone by adrenal explant cultures: response to potassium and converting enzyme inhibition. Endocrinology 1989 Jul; 125 (1): 486–91PubMedCrossRef

Granger CB, Ertl G, Kuch J, et al. Randomized trial of candesartan cilexetil in the treatment of patients with congestive heart failure and a history of intolerance to angiotensin-converting enzyme inhibitors. Am Heart J 2000 Apr; 139 (4): 609–17PubMedCrossRef

Sadjadi SA, McMillan JI, Jaipaul N, et al. A comparative study of the prevalence of hyperkalemia with the use of angiotensin-converting enzyme inhibitors versus angiotensin receptor blockers. Ther Clin Risk Manag 2009 Jun; 5 (3): 547–52PubMed

Winkelmayer WC, Zhang Z, Shahinfar S, et al. Efficacy and safety of angiotensin II receptor blockade in elderly patients with diabetes. Diabetes Care 2006 Oct; 29 (10): 2210–7PubMedCrossRef

10.

Yusuf S, Teo KK, Pogue J, et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 2008 Apr 10; 358 (15): 1547–59PubMedCrossRef

11.

Bootsma JE, Warle-van Herwaarden MF, Verbeek AL, et al. Adherence to biochemical monitoring recommendations in patients starting with Renin Angiotensin system inhibitors: a retrospective cohort study in the Netherlands. Drug Saf 2011 Jul 1; 34 (7): 605–14PubMedCrossRef

12.

Schaefer TJ, Wolford RW. Disorders of potassium. Emerg Med Clin North Am 2005 Aug; 23 (3): 723–47, viii-ixPubMedCrossRef

13.

Park MY, Yoon D, Lee K, et al. A novel algorithm for detection of adverse drug reaction signals using a hospital electronic medical record database. Pharmacoepidemiol Drug Saf 2011 Jun; 20 (6): 598–607PubMedCrossRef

14.

Yoon D, Park M, Choi N, et al. Detection of Adverse drug reaction signals using an electronic health records database: Comparison of the Laboratory Extreme Abnormality Ratio (CLEAR). Clin Pharmacol Ther 2012 Mar; 91 (3): 467–74PubMedCrossRef

15.

Shlipak MG. Pharmacotherapy for heart failure in patients with renal insufficiency. Ann Intern Med 2003 Jun 3; 138 (11): 917–24PubMedCrossRef

16.

Sundararajan V, Henderson T, Perry C, et al. New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality. J Clin Epidemiol 2004 Dec; 57 (12): 1288–94PubMedCrossRef

17.

Levey AS, Bosch JP, Lewis JB, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999 Mar 16; 130 (6): 461–70

18.

Cohn JN, Tognoni G. A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure. N Engl J Med 2001 Dec 6; 345 (23): 1667–75PubMedCrossRef

19.

Pfeffer MA, McMurray JJ, Velazquez EJ, et al. Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. N Engl J Med 2003 Nov 13; 349 (20): 1893–906PubMedCrossRef

20.

Palmer BF. Managing hyperkalemia caused by inhibitors of the renin-angiotensin-aldosterone system. N Engl J Med 2004 Aug 5; 351 (6): 585–92PubMedCrossRef

21.

Schupp M, Janke J, Clasen R, et al. Angiotensin type 1 receptor blockers induce peroxisome proliferator-activated receptor-gamma activity. Circulation 2004 May 4; 109 (17): 2054–7PubMedCrossRef

22.

Sanchez RA, Masnatta LD, Pesiney C, et al. Telmisartan improves insulin resistance in high renin nonmodulating salt-sensitive hypertensives. J Hypertens 2008 Dec; 26 (12): 2393–8PubMedCrossRef

23.

Schmidt B, Schieffer B. Angiotensin II AT1 receptor antagonists. Clinical implications of active metabolites. J Med Chem 2003 Jun 5; 46 (12): 2261–70

24.

Evans KJ, Greenberg A. Hyperkalemia: a review. J Intensive Care Med 2005 Sep–Oct; 20 (5): 272–90PubMedCrossRef

Title: Comparison of Hyperkalemic Risk in Hospitalized Patients Treated with Different Angiotensin Receptor Blockers
A Retrospective Cohort Study Using a Korean Clinical Research Database
Authors: Inwhee Park
Seung Soo Sheen
Hong-Seok Lim
Dukyong Yoon
Man Young Park
Suk-Hyang Lee
Gyu-Tae Shin
Heungsoo Kim
Dr Rae Woong Park
Publication date: 01-08-2012
Publisher: Springer International Publishing
Published in: American Journal of Cardiovascular Drugs / Issue 4/2012
Print ISSN: 1175-3277
Electronic ISSN: 1179-187X
DOI: https://doi.org/10.1007/BF03261834

2024 ASCO Annual Meeting

Springer Medicine

Comparison of Hyperkalemic Risk in Hospitalized Patients Treated with Different Angiotensin Receptor Blockers

A Retrospective Cohort Study Using a Korean Clinical Research Database

Abstract

Background and Aim

Methods

Results

Conclusion

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background and Aim

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2012

Evaluation of the Pharmacodynamics of Acetylsalicylic Acid 81 mg With or Without Esomeprazole 20 mg in Healthy Volunteers

Association of the Low-Density Lipoprotein Cholesterol/High-Density Lipoprotein Cholesterol Ratio and Body Mass Index with Coronary Plaque Regression

Patterns and Predictors of Use of Warfarin and Other Common Long-Term Medications in Patients with Atrial Fibrillation

Tolerability of Angiotensin-Receptor Blockers in Patients with Intolerance to Angiotensin-Converting Enzyme Inhibitors

Changes to the Statin Prescribing Policy in Belgium

Triple-Combination Therapy with Olmesartan, Amlodipine, and Hydrochlorothiazide in Black and Non-Black Study Participants with Hypertension