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

Joost C. Beusekamp, Jasper Tromp, Haye H. van der Wal, Stefan D. Anker, John G. Cleland, Kenneth Dickstein, Gerasimos Filippatos, Pim van der Harst, Hans L. Hillege, Chim C. Lang, Marco Metra, Leong L. Ng, Piotr Ponikowski, Nilesh J. Samani, Dirk J. van Veldhuisen, Aeilko H. Zwinderman, Patrick Rossignol, Faiez Zannad, Adriaan A. Voors, Peter van der Meer*

*Bijbehorende auteur voor dit werk

OnderzoeksoutputAcademicpeer review

56 Citaten (Scopus)

Samenvatting

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 <0.001). Baseline potassium was an independent predictor of lower ACEi/ARB dosage achieved [odds ratio 0.70; 95% confidence interval (CI) 0.51-0.98]. An increase in potassium was not associated with adverse outcomes (hazard ratio 1.15; 95% CI 0.86-1.53). No interaction on outcome was found between baseline potassium, potassium increase during uptitration, or potassium at 9 months and increased dosage of ACEi/ARB (P-interaction > 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.

Originele taal-2English
Pagina's (van-tot)923-930
Aantal pagina's8
TijdschriftEuropean Journal of Heart Failure
Volume20
Nummer van het tijdschrift5
DOI's
StatusPublished - mei-2018

Citeer dit