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Potassium and the use of renin-angiotensin-aldosterone system inhibitors in heart failure with reduced ejection fraction: data from BIOSTAT-CHF

Authors :
Beusekamp, Joost C
Tromp, Jasper
van der Wal, Haye H
Anker, Stefan D
Cleland, John G
Dickstein, Kenneth
Filippatos, Gerasimos
van der Harst, Pim
Hillege, Hans L
Lang, Chim C
Metra, Marco
Leong L, Ng
Ponikowski, Piotr
Samani, Nilesh J
van Veldhuisen, Dirk J
Zwinderman, Aeilko H
Rossignol, Patrick
Zannad, Faiez
Voors, Adriaan A
van der Meer, Peter
APH - Methodology
Epidemiology and Data Science
Cardiovascular Centre (CVC)
Life Course Epidemiology (LCE)
Groningen Kidney Center (GKC)
Restoring Organ Function by Means of Regenerative Medicine (REGENERATE)
Source :
European journal of heart failure, 20, 923-930. Wiley-Blackwell, European Journal of Heart Failure, 20(5), 923-930. Wiley
Publication Year :
2018

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 0.5 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.

Details

Language :
English
ISSN :
13889842
Database :
OpenAIRE
Journal :
European journal of heart failure, 20, 923-930. Wiley-Blackwell, European Journal of Heart Failure, 20(5), 923-930. Wiley
Accession number :
edsair.dedup.wf.001..5d14151b5fb2326b5fd3b9352e6c2db1