Hyperkalemia with angiotensin receptor blockers

Angiotensin receptor blockers show similar tolerability to ACE inhibitors with regard to hypotension and hyperkalemia, but they do not induce cough since ARBs do not cause an accumulation of bradykinin. Angiotensin receptor blockers can be considered in patients with ACE inhibitor-induced angioedema, but they should be initiated cautiously, as crossreactivity has been reported. Many of the other considerations for the use of ARBs are similar to those of ACE inhibitors,... 

Angiotensin receptor blockers (ARBs) Antagonize All effects at ATj receptors Like ACE inhibitors Like ACE inhibitors used in patients intolerant to ACE inhibitors Oral duration 6-8 h Toxicity Hyperkalemia angioneurotic edema Interactions Additive with other angiotensin antagonists... 

Treatment with angiotensin-converting enzyme inhibitors is also more likely to be associated with hyperkalemia in older individuals (69). Impaired angiotensin II formation limits this potent stimulus for aldosterone secretion, and this is superimposed on the already age-related decrease in activity of the renin-angiotensin-aldosterone axis. The same drug-induced hyporeninemic hypoaldosteronism is predicted for the angiotensin receptor blockers. However, to date this has not been documented clincally. 

Dyazide) < 30 mL/min) may cause hyperkalemia, especially in combination with an ACE inhibitor, angiotensin-receptor blocker, or potassium supplements... 

Besides hypotension, the most frequent adverse reaction to an ACE inhibitor is cough, which may occur in up to 30% of patients. Patients with ACE inhibitor cough and either clinical signs of heart failure or LVEE less than 40% may be prescribed an angiotensin-receptor blocker (ARB). Both candesartan and valsartan have improved outcomes in clinical trials in patients with heart failure. Other less common but more serious adverse effects of ACE inhibitors include acute renal failure, hyperkalemia, and angioedema. Although some data have suggested that aspirin use may decrease the benefits from ACE inhibitor treatment, a systematic review of more than 20,000 patients demonstrated that ACE inhibitors improve outcome irrespective of treatment with aspirin. ... 

Urinary tract Acute renal insufficiency with hyperkalemia has been reported in a 76-year-old hypertensive woman taking both aliskiren and spironolactone [68 ]. Preexisting renal impairment and concomitant use of an aldosterone receptor antagonist were predisposing factors, and it is not surprising that the same pattern of adverse effects is seen in cases like this as have been seen with ACE inhibitors and angiotensin receptor blockers before. 

Medications can increase the risk of hyperkalemia in patients with CKD, including angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, used for the treatment of proteinuria and hypertension. Potassium-sparing diuretics, used for the treatment of edema and chronic heart failure, can also exacerbate the development of hyperkalemia, and should be used with caution in patients with stage 3 CKD or higher. 

Hyperkalemia should not be treated with drugs that interfere with aldosterone production (eg, losartan, an angiotensin II receptor blocker) or collecting tubule potassium excretion (eg, amiloride, spironolactone, triamterene). These agents are all capable of increasing serum potassium. Hydrochlorothiazide would not reduce serum potassium rapidly, but it would not increase it. The answer is (B). 

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