title: A comparative study of the prevalence of hyperkalemia with the use of angiotensin-converting enzyme inhibitors versus angiotensin receptor blockers.
abstract: OBJECTIVE
  Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) are increasingly used in a variety of settings including heart failure, renal failure, arterial hypertension, and diabetic nephropathy. The objective of this study was to investigate the prevalence of hyperkalemia with ACEI and ARB use, in a population of the United States veterans. DESIGN, SETTINGS, MATERIAL, AND MEASUREMENTS: Retrospective observational cohort study of 1163 patients on ACEIs and 1168 patients on ARBs in a single Veterans Affairs Medical Center. Electronic medical records were reviewed over a 12-month period with data collected on various demographic, laboratory, comorbidity, and medication related variables.
  
  
  RESULTS
  Hyperkalemia (>5 mEq/L) was observed in 20.4% of patients on ACEIs and 31.0% on ARBs. Severe hyperkalemia (6 mEq/L or higher), was observed in 0.8% of ACEI and 2.8% of ARB users. In univariate logistic regression analyses, diabetes mellitus; serum glucose, total carbon dioxide content, creatinine, and estimated glomerular filtration rate (GFR) were significantly associated with hyperkalemia. ARB use, when compared to ACEI, was associated with a 42% increase in odds of hyperkalemia (odds ratio [OR] = 1.42; p = 0.001) in a model including adjustment for GFR and a 56% increase in odds of hyperkalemia (OR = 1.56; p < 0.001) in a model including adjustment for serum creatinine.
  
  
  CONCLUSIONS
  Hyperkalemia, associated with the use of ACEIs and ARBs, is usually mild and severe hyperkalemia is rare. Hyperkalemia is more common with ARBs than ACEIs. ARB use, when compared to ACEI use, may significantly and independently be associated with increased odds of hyperkalemia.
authors.affiliation: Section of Nephrology (111N), Jerry L Pettis Memorial Veterans Medical Center, Loma Linda, CA, USA.
authors.forename: Seyed Ali
authors.initials: SA
authors.lastname: Sadjadi
authors.forename: James I
authors.initials: JI
authors.lastname: McMillan
authors.forename: Navin
authors.initials: N
authors.lastname: Jaipaul
authors.forename: Patricia
authors.initials: P
authors.lastname: Blakely
authors.forename: Su Su
authors.initials: SS
authors.lastname: Hline
references.citation: Am J Med. 2002 Feb 1;112(2):110-4
references.pmid: 11835948
references.citation: Kidney Int. 2000 Nov;58(5):2084-92
references.pmid: 11044229
references.citation: N Engl J Med. 2001 Dec 6;345(23):1667-75
references.pmid: 11759645
references.citation: N Engl J Med. 2003 May 15;348(20):2007-18
references.pmid: 12748317
references.citation: N Engl J Med. 1990 May 3;322(18):1290-2
references.pmid: 2325722
references.citation: Congest Heart Fail. 2000 Jul-Aug;6(4):193-196
references.pmid: 12147952
references.citation: N Engl J Med. 2001 May 31;344(22):1651-8
references.pmid: 11386263
references.citation: Semin Nephrol. 2004 May;24(3):218-24
references.pmid: 15156527
references.citation: J Clin Pharmacol. 2002 Jul;42(7):754-61
references.pmid: 12092742
references.citation: Am Heart J. 2000 Apr;139(4):609-17
references.pmid: 10740141
references.citation: Intern Med. 2007;46(12):823-9
references.pmid: 17575373
references.citation: J Renin Angiotensin Aldosterone Syst. 2003 Mar;4(1):43-7
references.pmid: 12692753
references.citation: N Engl J Med. 2004 Aug 5;351(6):543-51
references.pmid: 15295047
references.citation: N Engl J Med. 2003 Apr 3;348(14):1309-21
references.pmid: 12668699
references.citation: N Engl J Med. 2001 Sep 20;345(12):851-60
references.pmid: 11565517
references.citation: N Engl J Med. 1999 Sep 2;341(10):709-17
references.pmid: 10471456
references.citation: Arch Intern Med. 2001 Jan 22;161(2):165-71
references.pmid: 11176729
references.citation: J Am Geriatr Soc. 2003 Jan;51(1):123-6
references.pmid: 12534856
references.citation: Diabetes Care. 2003 May;26(5):1402-7
references.pmid: 12716796
references.citation: Arch Intern Med. 2000 Jun 12;160(11):1605-11
references.pmid: 10847253
references.citation: N Engl J Med. 2003 Nov 13;349(20):1893-906
references.pmid: 14610160
references.citation: QJM. 2005 Mar;98(3):199-203
references.pmid: 15728401
references.citation: Nephron Clin Pract. 2005;99(1):c18-23
references.pmid: 15637459
references.citation: J Card Fail. 2007 Aug;13(6):422-30
references.pmid: 17675055
references.citation: N Engl J Med. 2004 Aug 5;351(6):585-92
references.pmid: 15295051
references.citation: Ann Intern Med. 2003 Jun 3;138(11):917-24
references.pmid: 12779302
references.citation: Clin J Am Soc Nephrol. 2009 Apr;4(4):820-9
references.pmid: 19346430
references.citation: Diabetes Care. 2006 Oct;29(10):2210-7
references.pmid: 17003295
references.citation: Curr Opin Nephrol Hypertens. 2002 Jul;11(4):377-81
references.pmid: 12105385
references.citation: N Engl J Med. 2008 Apr 10;358(15):1547-59
references.pmid: 18378520
references.citation: Am J Kidney Dis. 2006 May;47(5):751-60
references.pmid: 16632013
references.citation: J Gen Intern Med. 2000 Dec;15(12):885-90
references.pmid: 11119186