• Santiago Jiménez-Marrero, Miguel Cainzos-Achirica, David Monterde, Emili Vela, Cristina Enjuanes, Sergi Yun, Alberto Garay, Pedro Moliner, Miriam Corbella, Sílvia Jovells-Vaqué, Lídia Alcoberro, Alexandra Pons-Riverola, Raul Ramos-Polo, Herminio Morillas, Joan Antoni Gómez-Hospital, and Josep Comin-Colet.
• Bioheart Group, Cardiovascular, Respiratory and Systemic Diseases and cellular aging Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Spain; Community Heart Failure Program, Cardiology and Internal Medicine Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona Spain; Ciber Cardiovascular group (CIBER-CV), Instituto Salud Carlos III, Madrid, Spain.
• Eur. J. Intern. Med. 2024 Jul 1; 125: 899789-97.

BackgroundRenin-angiotensin-aldosterone system inhibitors (RAASIs) play a crucial role in the treatment of several chronic cardiovascular conditions. Nonetheless, hyperkalemia, a frequent side effect, often leads to the discontinuation of RAASIs. The implications of hyperkalemia-driven changes in RAASI medications are poorly understood.MethodsPopulation-based, observational, retrospective cohort study. Two large healthcare databases were utilized to identify 77,089 individuals aged 55 years and older with chronic conditions who were prescribed RAASIs between 2015 and 2017 in Southern Barcelona, Spain. We assessed the interplay between serum potassium abnormalities, RAASI management, and their associations with clinical outcomes, adjusting for potential confounders including socioeconomic factors, medical conditions, and potassium levels.ResultsThe one-year prevalence of hyperkalemia (defined as serum potassium, K+ >5.0 mmol/L) was 17.8 %. RAASI were down-titrated in 16.1 % of these 13,673 patients with K+ levels. Factors linked to a higher likelihood of reducing/discontinuing RAASI after developing hyperkalemia included older age, impaired kidney function, higher potassium levels, and previous hospitalizations. Dose reduction/discontinuation of RAASI after developing hyperkalemia was associated with an increased risk of hospitalization (adjusted hazard ratio [HR] 1.16, 95 % confidence interval [CI] 1.10-1.21) and with increased mortality (HR 1.60, 95 % CI 1.56-1.84).ConclusionIn this large, observational study, hyperkalemia was linked to a greater likelihood of discontinuing RAASIs. Down-titration of RAASI was independently associated with unfavorable clinical outcomes such as hospitalization and specially mortality. Although the observational nature of the study, these findings underscore the importance of preventing circumstances that may lead to RAASI down-titration, such as hyperkalemia, as well as preventing hospitalizations and mortality, to ensure RAASI benefits.Copyright © 2024. Published by Elsevier B.V.

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