Stopping RASi treatment suppresses hyperkalaemia recurrence but ups death, MACE risk

Terminating treatment with renin-angiotensin system inhibitors (RASi) after hyperkalaemia may lower the likelihood of recurrence but aggravate the risks of death and cardiovascular events, a new study has found.

Researchers conducted an observational analysis of 5,699 new RASi users who had survived their first-detected episode of hyperkalaemia. Stopping vs continuing RASi within 6 months after hyperkalaemia were compared in terms of the 3-year risks of the following outcomes: mortality, recurrent hyperkalaemia, and major adverse cardiovascular events (MACE, composite of stroke hospitalization, myocardial infarction, and cardiovascular death).

Twenty-five percent (n=1,425) of participants stopped RASi therapy within 6 months of the hyperkalaemia episode; the remaining 4,244 remained on the medication. The 3-year estimates for risk of death were 31.6 percent for stoppers and 20.8 percent for continuers. The corresponding risk difference (10.8 percent) was found to be statistically significant (hazard ratio [HR], 1.49, 95 percent confidence interval [CI], 1.34–1.64).

Similarly, 3-year MACE risk was significantly elevated in patients who stopped RASi treatment (risk difference, 4.7 percent; HR, 1.29, 95 percent CI, 1.14–1.45).

In contrast, the 3-year estimated risk for recurrent hyperkalaemia was higher in those who continued vs stopped RASi treatment (39.2 percent vs 29.7 percent; HR, 0.76, 95 percent CI, 0.69–0.84).

“We conclude that in this large community-based cohort of RASi users who developed hyperkalaemia, stopping therapy was associated with a lower risk of hyperkalaemia, but the patient-important events, MACE and death, were lower in those who continued,” the researchers said.