title: Adequate intake of potassium does not cause hyperkalemia in hypertensive individuals taking medications that antagonize the renin angiotensin aldosterone system.
abstract: Reduced potassium excretion caused by angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) may increase the risk of hyperkalemia (serum potassium concentration >5 mmol/L) in the setting of increased potassium intake.
  
  
  
  The purpose of this study was to assess the effect of increasing dietary potassium on serum potassium concentration in hypertensive individuals with normal renal function treated with an ACEi or ARB. We hypothesized that an increase in dietary potassium would not provoke hyperkalemia in this population despite treatment with either an ACEi or ARB.
  
  
  
  We conducted a controlled, parallel-design clinical trial in 20 hypertensive subjects with normal renal function treated with an ACEi or ARB, with random assignment to a usual diet or a high-potassium diet (HKD). Fruit and vegetable intake was used to increase potassium intake. Serum potassium concentration, 3-d food records, and 24-h urine collections were completed at baseline and 4 wk.
  
  
  
  In the usual-diet group there were no statistically significant differences for potassium excretion, intake, or serum levels at end of study compared with baseline. The HKD group had significant differences in urinary potassium excretion (83 ± 26 mmol/d at baseline compared with 109 ± 35 mmol/d at 4 wk, P = 0.01) and dietary potassium intake (3775 ± 1189 mg/d at baseline compared with 5212 ± 1295 mg/d at 4 wk, P = 0.02). Despite increased potassium intake in the HKD group, serum potassium concentrations did not significantly increase from baseline at midpoint or end of study (4.1 ± 0.6, 4.3 ± 0.3, and 4.2 ± 0.4 mmol/L, respectively).
  
  
  
  This study demonstrates that an increase in dietary potassium over a 4-wk period is safe in hypertensive subjects who have normal renal function and are receiving ACEi and/or ARB therapy. This trial was registered at www.clinicaltrials.gov as NCT02759367.
authors: Department of Nutritional Sciences, University of Toronto, Toronto, ON; Divisions of Cardiology and.
authors: Daniela
authors: D
authors: Malta
authors: Department of Nutritional Sciences, University of Toronto, Toronto, ON; Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON.
authors: JoAnne
authors: J
authors: Arcand
authors: Divisions of Cardiology and.
authors: Anju
authors: A
authors: Ravindran
authors: Divisions of Cardiology and.
authors: Vanessa
authors: V
authors: Floras
authors: Department of Nutritional Sciences, University of Toronto, Toronto, ON; Gastroenterology, Department of Medicine, Sinai Health System and University Health Network, Toronto, ON; and.
authors: Johane P
authors: JP
authors: Allard
authors: Divisions of Cardiology and gnewton@mtsinai.on.ca.
authors: Gary E
authors: GE
authors: Newton
mesh_terms: D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D004032:Diet; D005247:Feeding Behavior; D005260:Female; D018565:Food-Drug Interactions; D006801:Humans; D006947:Hyperkalemia / Q000097:blood* / Q000209:etiology; D006973:Hypertension / Q000097:blood / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000008:administration & dosage* / Q000097:blood / Q000494:pharmacology; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012307:Risk Factors
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D011188:Potassium
keywords: angiotensin-converting enzyme inhibitor; hypertension; nutrition; potassium; β-blocker