Potassium and the use of renin–angiotensin–aldosterone system inhibitors in heart failure with reduced ejection fraction

Beusekamp, J. C. et al. (2018) Potassium and the use of renin–angiotensin–aldosterone system inhibitors in heart failure with reduced ejection fraction. European Journal of Heart Failure, 20(5), pp. 923-930. (doi: 10.1002/ejhf.1079) (PMID:29359813)

Abstract

Background: Hyperkalaemia is a common co-morbidity in patients with heart failure with reduced ejection fraction (HFrEF). Whether it affects the use of renin–angiotensin–aldosterone system inhibitors and thereby negatively impacts outcome is unknown. Therefore, we investigated the association between potassium and uptitration of angiotensin-converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARB) and its association with outcome. Methods and results: Out of 2516 patients from the BIOSTAT-CHF study, potassium levels were available in 1666 patients with HFrEF. These patients were sub-optimally treated with ACEi/ARB or beta-blockers and were anticipated and encouraged to be uptitrated. Potassium levels were available at inclusion and at 9 months. Outcome was a composite of all-cause mortality and heart failure hospitalization at 2 years. Patients' mean age was 67 ± 12 years and 77% were male. At baseline, median serum potassium was 4.3 (interquartile range 3.9–4.6) mEq/L. After 9 months, 401 (24.1%) patients were successfully uptitrated with ACEi/ARB. During this period, mean serum potassium increased by 0.16 ± 0.66 mEq/L (P < 0.001). Baseline potassium was an independent predictor of lower ACEi/ARB dosage achieved [odds ratio 0.70; 95% confidence interval (CI) 0.51–0.98]. An increase in potassium was not associated with adverse outcomes (hazard ratio 1.15; 95% CI 0.86–1.53). No interaction on outcome was found between baseline potassium, potassium increase during uptitration, or potassium at 9 months and increased dosage of ACEi/ARB (Pinteraction > 0.5 for all). Conclusion: Higher potassium levels are an independent predictor of enduring lower dosages of ACEi/ARB. Higher potassium levels do not attenuate the beneficial effects of ACEi/ARB uptitration.

• Item Type: Articles
• Additional Information: IOSTAT-CHF was funded by the European Commission[FP7-242209-BIOSTAT-CHF; EudraCT 2010-020808-29].
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Cleland, Professor John
• Authors: Beusekamp, J. C., Tromp, J., van der Wal, H. H., Anker, S. D., Cleland, J. G., Dickstein, K., Filippatos, G., van der Harst, P., Hillege, H. L., Lang, C. C., Metra, M., Ng, L. L., Ponikowski, P., Samani, N. J., van Veldhuisen, D. J., Zwinderman, A. H., Rossignol, P., Zannad, F., Voors, A. A., and van der Meer, P.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: European Journal of Heart Failure
• Publisher: Wiley
• ISSN: 1388-9842
• ISSN (Online): 1879-0844
• Published Online: 12 January 2018
• Copyright Holders: Copyright © 2018 The Authors
• First Published: First published in European Journal of Heart Failure 20(5): 923-930
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher