title: Antihypertensive Medications and the Prevalence of Hyperkalemia in a Large Health System.
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, <2, 2 to 4, and ≥4 potassium measurements per year were 20%, 58%, 16%, and 6%. Potassium levels >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.
authors.affiliation: From the Division of Nephrology, Geisinger Health System, Danville, PA (A.R.C., J.L., T.Y.); Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD (Y.S., K.M., S.H.B., J.C., M.E.G.); Geisinger Health System, Biomedical and Translational Informatics, Danville, PA (H.L.K.); Division of Nephrology, Tufts Medical Center, Boston, MA (L.A.I.); and Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD (M.E.G.). achang@geisinger.edu.
authors.forename: Alex R
authors.initials: AR
authors.lastname: Chang
authors.affiliation: From the Division of Nephrology, Geisinger Health System, Danville, PA (A.R.C., J.L., T.Y.); Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD (Y.S., K.M., S.H.B., J.C., M.E.G.); Geisinger Health System, Biomedical and Translational Informatics, Danville, PA (H.L.K.); Division of Nephrology, Tufts Medical Center, Boston, MA (L.A.I.); and Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD (M.E.G.).
authors.forename: Yingying
authors.initials: Y
authors.lastname: Sang
authors.affiliation: From the Division of Nephrology, Geisinger Health System, Danville, PA (A.R.C., J.L., T.Y.); Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD (Y.S., K.M., S.H.B., J.C., M.E.G.); Geisinger Health System, Biomedical and Translational Informatics, Danville, PA (H.L.K.); Division of Nephrology, Tufts Medical Center, Boston, MA (L.A.I.); and Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD (M.E.G.).
authors.forename: Julia
authors.initials: J
authors.lastname: Leddy
authors.affiliation: From the Division of Nephrology, Geisinger Health System, Danville, PA (A.R.C., J.L., T.Y.); Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD (Y.S., K.M., S.H.B., J.C., M.E.G.); Geisinger Health System, Biomedical and Translational Informatics, Danville, PA (H.L.K.); Division of Nephrology, Tufts Medical Center, Boston, MA (L.A.I.); and Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD (M.E.G.).
authors.forename: Taher
authors.initials: T
authors.lastname: Yahya
authors.affiliation: From the Division of Nephrology, Geisinger Health System, Danville, PA (A.R.C., J.L., T.Y.); Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD (Y.S., K.M., S.H.B., J.C., M.E.G.); Geisinger Health System, Biomedical and Translational Informatics, Danville, PA (H.L.K.); Division of Nephrology, Tufts Medical Center, Boston, MA (L.A.I.); and Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD (M.E.G.).
authors.forename: H Lester
authors.initials: HL
authors.lastname: Kirchner
authors.affiliation: From the Division of Nephrology, Geisinger Health System, Danville, PA (A.R.C., J.L., T.Y.); Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD (Y.S., K.M., S.H.B., J.C., M.E.G.); Geisinger Health System, Biomedical and Translational Informatics, Danville, PA (H.L.K.); Division of Nephrology, Tufts Medical Center, Boston, MA (L.A.I.); and Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD (M.E.G.).
authors.forename: Lesley A
authors.initials: LA
authors.lastname: Inker
authors.affiliation: From the Division of Nephrology, Geisinger Health System, Danville, PA (A.R.C., J.L., T.Y.); Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD (Y.S., K.M., S.H.B., J.C., M.E.G.); Geisinger Health System, Biomedical and Translational Informatics, Danville, PA (H.L.K.); Division of Nephrology, Tufts Medical Center, Boston, MA (L.A.I.); and Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD (M.E.G.).
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Matsushita
authors.affiliation: From the Division of Nephrology, Geisinger Health System, Danville, PA (A.R.C., J.L., T.Y.); Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD (Y.S., K.M., S.H.B., J.C., M.E.G.); Geisinger Health System, Biomedical and Translational Informatics, Danville, PA (H.L.K.); Division of Nephrology, Tufts Medical Center, Boston, MA (L.A.I.); and Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD (M.E.G.).
authors.forename: Shoshana H
authors.initials: SH
authors.lastname: Ballew
authors.affiliation: From the Division of Nephrology, Geisinger Health System, Danville, PA (A.R.C., J.L., T.Y.); Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD (Y.S., K.M., S.H.B., J.C., M.E.G.); Geisinger Health System, Biomedical and Translational Informatics, Danville, PA (H.L.K.); Division of Nephrology, Tufts Medical Center, Boston, MA (L.A.I.); and Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD (M.E.G.).
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
authors.affiliation: From the Division of Nephrology, Geisinger Health System, Danville, PA (A.R.C., J.L., T.Y.); Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD (Y.S., K.M., S.H.B., J.C., M.E.G.); Geisinger Health System, Biomedical and Translational Informatics, Danville, PA (H.L.K.); Division of Nephrology, Tufts Medical Center, Boston, MA (L.A.I.); and Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD (M.E.G.).
authors.forename: Morgan E
authors.initials: ME
authors.lastname: Grams
mesh_terms: D017677:Age Distribution; D057911:Angiotensin Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D003695:Delivery of Health Care; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced* / Q000453:epidemiology* / Q000503:physiopathology; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010414:Pennsylvania; D015995:Prevalence; D011379:Prognosis; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012720:Severity of Illness Index; D017678:Sex Distribution
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents
keywords: antihypertensive; hyperkalemia; medications; potassium; renin–angiotensin–aldosterone system