Abstract 14093: Hyperkalemia Associated with Medications Targeting the Renin-Angiotensin-Aldosterone System: Incidence and Withdrawal Rate in a Meta-Analysis of Randomized Trials
Background: Hyperkalemia is considered to be a common adverse effect of Renin-Angiotensin-Aldosterone system (RAAS) blockers. There has been controversy over the incidence of this side effect, which has reduced their use.
Methods: A PubMed and Cochrane search from randomized clinical trials was done from 1960 to 2011. We pooled all trials in which the incidence of hyperkalemia was compared among any RAAS blocker to another antihypertensive drug class in hypertensive patients. Effect estimates were pooled across studies using random-effects meta-analysis and heterogeneity was assessed using I2 statistics. (RevMan 5)
Results: Thirty-six studies with a total patient population of 35407 (mean age of 59±7, 62% males, follow up of 26 weeks±4) were included; 10 studies with angiotensin-converting enzyme inhibitors (ACEi), 8 with angiotensin receptor blockers (ARBs), 14 with aldosterone inhibitors and 4 with direct renin inhibitors. Hyperkalemia was defined as a serum potassium concentration above 5.5 meq/L. The weighted incidence of hyperkalemia was significantly higher in RAAS blockers when compared with controls (1.8% vs. 1.1%, RR: 1.80 [1.34-2.40]; P<0.0001). However, only ACEi and ARBs showed statistical significance (2.1% vs. 0.9%, RR: 2.27 [1.57,3.28]; P<0.0001 and 1.8% vs. 1.1%, RR: 1.93 [1.18-3.18]; P=0.009 respectively). The mean incidence for aldosterone inhibitors was 1.15% vs. 0.5%, RR: 1.86 [0.56, 6.38]; P=0.31 and for direct renin inhibitors was 2.3 vs. 3.04, RR: 1.07 [0.50,2.27]; P=0.87. The withdrawal rate due to hyperkalemia was not significant between RAAS blockers and controls (0.4% vs. 0.1%, RR: 2.24 [0.64,7.87]; P=0.21).
Conclusion: The incidence of hyperkalemia in patients on RAAS blockers was significant when compared to control/placebo. However, the incidence was low and only significant on the ACEi and ARBs groups. Aldosterone inhibitors and direct renin inhibitors seem to be safe when administered to hypertensive patients.
- © 2011 by American Heart Association, Inc.