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Eur Heart J Cardiovasc Pharmacother. 2018 Jul 1;4(3):180-188. doi: 10.1093/ehjcvp/pvy015.

Expert consensus document on the management of hyperkalaemia in patients with cardiovascular disease treated with renin angiotensin aldosterone system inhibitors: coordinated by the Working Group on Cardiovascular Pharmacotherapy of the European Society of Cardiology.

Author information

1
Department of Medical Sciences, IRCCS San Raffaele, via di val cannuta, Roma, Italy.
2
Cardiology Clinical Academic Group, St George's Hospitals NHS Trust University of London, Cranmer Terrace, London, UK.
3
Department of Pharmacology, School of Medicine. University Complutense, CIBERCV, 28040 Madrid, Spain.
4
Department of Medicine, Copenhagen University Hospital (Holbæk Hospital), Holbæk, Denmark.
5
Institute for Clinical Medicine, Copenhagen University, Blegdamsvej 3B, 2200 Copenhagen N, Denmark.
6
Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7 D2 DK-9220 Aalborg East, Denmark.
7
Faculty of Medicine, University of Ljubljana; Department of Internal Medicine, General Hospital Murska Sobota, Slovenia.
8
Oslo University Hospital, Oslo universitetssykehus HF, Postboks 4950 Nydalen, 0424 Oslo, Ullevål, Norway.
9
Institute of Clinical Sciences, University of Oslo, Oslo universitetssykehus HF, Postboks 4950 Nydalen, 0424 Oslo, Norway.
10
Division of Cardiology and Metabolism, Department of Cardiology (CVK); and Berlin-Brandenburg Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charité Universitätsmedizin Berlin, Germany.
11
Department of Cardiology and Pneumology, University Medicine Göttingen (UMG), Göttingen, Germany.
12
University Hospital of Ferrara, U.O. Cardiologia Via Savonarola, 9, 44121 Ferrara FE, Italy.
13
Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria.
14
Department of Internal Medicine, Academic Teaching Hospital Feldkirch, Feldkirch, Austria.
15
University of the Principality of Liechtenstein, Triesen, Liechtenstein.
16
National and Kapodistrian University of Athens, School of Medicine, Attikon University Hospital, 75 Mikras Asias str., 11527 Goudi, Athens, Greece.
17
Karolinska Institutet, and Karolinska University Hospital, Solna, SE-171 76 Stockholm, Sweden.
18
Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, Austria.
19
Department of Heart Diseases, Wroclaw Medical University, Centre for Heart Diseases, Military Hospital, Wroclaw, Poland.
20
Department of Emergency Medicine, Holbaek Hospital, University of Copenhagen, Holbæk, Denmark.
21
Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
22
Department of Cardiology, University of Belgrade, Studentski trg 1, 11000 Belgrade, Serbia.
23
Cardiology Pasing, Munich, Germany.
24
University of the Saarland, Homburg/Saar, Germany.
25
Department of Pharmacology and Therapeutics, School of Medicine and School of Pharmacy, University College Cork, Cork, Ireland.
26
Institute of Medical Biochemistry and Molecular Biology, University Medicine Greifswald, Greifswald, Germany.
27
Lady Davis Carmel Medical Center, Mikhal St 7, Haifa 3436212, Israel.
28
Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, 1 Efron St. Bat Galim, Haifa 3525433, Israel.

Abstract

Renin angiotensin aldosterone system inhibitors/antagonists/blockers (RAASi) are a cornerstone in treatment of patients with cardiovascular diseases especially in those with heart failure (HF) due to their proven effect on surrogate and hard endpoints. Renin angiotensin aldosterone system inhibitors are also the basis in treatment of arterial hypertension, and they are furthermore indicated to reduce events and target organ damage in patients with diabetes and chronic kidney disease, where they have specific indication because of the evidence of benefit. Renin angiotensin aldosterone system inhibitor therapy, however, is associated with an increased risk of hyperkalaemia. Patients with chronic kidney disease and HF are at increased risk of hyperkalaemia and ∼50% of these patients experience two or more yearly recurrences. A substantial proportion of patients receiving RAASi therapy have their therapy down-titrated or more often discontinued even after a single episode of elevated potassium (K+) level. Since RAASi therapy reduces mortality and morbidity in patients with cardiovascular disease steps should, when hyperkalaemia develops, be considered to lower K+ level and enable patients to continue their RAASi therapy. The use of such measures are especially important in those patients with the most to gain from RAASi therapy.

PMID:
29726985
DOI:
10.1093/ehjcvp/pvy015
[Indexed for MEDLINE]

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