Hyperkalemia in the Hypertensive Patient

• Published in: Current cardiology reports 2018-02, Vol.20 (2), p.12-12, Article 12
• Main Authors: Lakkis, Jay Ian, Weir, Matthew R.
• Format: Article
• Language: English
• Subjects: Angiotensin-Converting Enzyme Inhibitors - adverse effects; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Antihypertensive Agents - adverse effects; Antihypertensive Agents - therapeutic use; Cardiology; Cation Exchange Resins - chemistry; Diabetic Nephropathies - complications; Heart Failure - complications; Humans; Hyperkalemia - chemically induced; Hyperkalemia - therapy; Hypertension (DS Geller and DL Cohen; Hypertension - drug therapy; Medicine; Medicine & Public Health; Randomized Controlled Trials as Topic; Renal Dialysis; Renal Insufficiency, Chronic - blood; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - therapy; Renin-Angiotensin System - drug effects; Section Editors; Topical Collection on Hypertension
• ISSN: 1523-3782; 1534-3170
• DOI: 10.1007/s11886-018-0954-2

Purpose of Review Hyperkalemia develops in a patient with systemic arterial hypertension (HTN) if one or more risk factors are present, namely chronic kidney disease (CKD) (especially severe stage 4-5 CKD), diabetes mellitus (DM), heart failure (HF), or pharmacological therapies that interfere with potassium homeostasis, mainly through renin-angiotensin-aldosterone inhibition (RAASi). Hyperkalemia is a considerable reason of morbidity (emergency department (ED) visits and hospitalizations) and portends a higher mortality risk in patients at risk; for instance, hyperkalemia increases the risk of mortality within 1 day of a hyperkalemic event. This review aims to identify the risk factors for high-serum potassium, highlight the risk versus benefit of RAASi in certain patient populations, and outline preventive as well as therapeutic strategies for hyperkalemia. Recent Findings A growing body of evidence supports the safety and efficacy of cation-exchange resins, patiromer, or sodium zirconium cyclosilicate, in patients with a compelling indication for RAASi, yet in whom such therapy was complicated by hyperkalemia, allowing these patients to benefit from continued RAASi therapy. Summary In summary, novel cation exchange polymers present the clinician with a new and safe strategy to address hyperkalemia in patients with a compelling indication for ongoing RAASi therapy instead of withdrawal of such therapy.