• Alex R Chang, Yingying Sang, Julia Leddy, Taher Yahya, H Lester Kirchner, Lesley A Inker, Kunihiro Matsushita, Shoshana H Ballew, Josef Coresh, and Morgan E Grams.
• 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.
• Hypertension. 2016 Jun 1; 67 (6): 1181-8.

AbstractLittle 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.© 2016 American Heart Association, Inc.

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