Does lisinopril cause hyperkalemia

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Lisinopril and Hyperkalemia: Analyzing the Risks

Introduction to Lisinopril and Hyperkalemia

Lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, is widely used to manage hypertension and chronic kidney disease (CKD). However, one of its known side effects is hyperkalemia, a condition characterized by elevated potassium levels in the blood, which can have serious health implications.

Incidence of Hyperkalemia with Lisinopril

Several studies have documented the incidence of hyperkalemia in patients treated with lisinopril. In the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial, the incidence of hyperkalemia was found to be higher in patients treated with lisinopril (3.6%) compared to those treated with chlorthalidone (1.2%) or amlodipine (1.9%) . Another study comparing lisinopril to losartan, an angiotensin II receptor blocker (ARB), also highlighted hyperkalemia as a significant side effect of lisinopril .

Risk Factors for Hyperkalemia

Patients with chronic kidney disease (CKD) are particularly at risk for hyperkalemia when treated with lisinopril. A study focusing on CKD patients starting lisinopril treatment emphasized the need for careful monitoring due to the elevated risk of hyperkalemia . Additionally, the combination of lisinopril with other medications that increase potassium levels, such as spironolactone or potassium supplements, can further elevate the risk .

Clinical Consequences of Hyperkalemia

Hyperkalemia can lead to severe clinical outcomes, including cardiovascular events and muscle paralysis. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial found that hyperkalemia was associated with an increased risk of combined cardiovascular disease . Cases of severe muscle weakness and paralysis due to hyperkalemia have also been reported, underscoring the potential severity of this condition 78.

Combination Therapy and Hyperkalemia

The use of combination therapy involving lisinopril and other RAAS inhibitors, such as ARBs, has been explored to enhance therapeutic outcomes. However, studies like the VA NEPHRON-D trial have shown that such combinations significantly increase the risk of hyperkalemia and acute kidney injury without providing additional benefits in terms of slowing disease progression 3910.

Conclusion

Lisinopril is an effective medication for managing hypertension and CKD, but it carries a notable risk of hyperkalemia, especially in patients with pre-existing kidney conditions or those on combination therapies. Clinicians should carefully monitor potassium levels in patients prescribed lisinopril to mitigate the risk of hyperkalemia and its associated complications.

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Most relevant research papers on this topic

Clinical Significance of Incident Hypokalemia and Hyperkalemia in Treated Hypertensive Patients in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial

Hypokalemia and hyperkalemia are common in hypertensive patients, but their impact on mortality is unrelated to the specific effects of thiazide diuretics.

RCTRigorous Journal

2012·

69citations

·M. Alderman et al.

Incidence of hyperkalemia in high risk patients during treatment with an angiotensin converting enzyme inhibitor (Lisinopril) versus an angiotensin II receptor blocker (Losartan).

Angiotensin II receptor blocker (Losartan) is less likely to cause hyperkalemia than ACEI (Lisinopril) in high-risk patients with a history of high normal serum potassium levels.

Non-RCT

2004·

1citation

·A. R. Zanabli et al.

Adding lisinopril to losartan increased hyperkalemia and acute kidney injury in type 2 diabetes and proteinuria

Adding lisinopril to losartan increased the risk of hyperkalemia and acute kidney injury in veterans with type 2 diabetes and proteinuria.

RCTLarge Human Trial

2014·

3citations

·C. Clase et al.

Predicting the risk of hyperkalemia in patients with chronic kidney disease starting lisinopril

A prognostic risk score can predict the risk of hyperkalemia in patients with chronic kidney disease starting lisinopril, potentially improving management.

2010·

43citations

·Eric S. Johnson et al.

An Unexpected Case of Lisinopril-Associated Severe Hyponatremia

Lisinopril use may be associated with severe hyponatremia, a rare but potentially serious side effect.

Case ReportRigorous Journal

2020·

4citations

·Yiran Jiang et al.

Lisinopril in hypertensive patients with renal function impairment.

Lisinopril is an effective antihypertensive drug for patients with impaired renal function, with dose adjustment based on pretreatment GFR and a gradual decrease in dosage during prolonged treatment.

Observational Study

1990·

13citations

·P. D. de Jong et al.

Hyperkalemia‐Induced Paralysis

Hyperkalemia-induced paralysis is a rare but potentially life-threatening noncardiac toxicity, and clinicians should be aware of this potentially life-threatening noncardiac toxicity.

Case Report

2009·

12citations

·Nikita S. Wilson et al.

Acute Ascending Muscle Weakness Secondary to Medication-Induced Hyperkalemia

Drug-induced hyperkalemia can cause acute ascending muscle weakness, but with close monitoring, symptoms and electrocardiogram return to baseline within 24 hours without dialysis.

Case Report

2014·

13citations

·Lauren A Kimmons et al.

Angiotensin blockade in late autosomal dominant polycystic kidney disease.

Monotherapy with an ACE inhibitor effectively controls blood pressure in most patients with autosomal dominant polycystic kidney disease and stage 3 chronic kidney disease, while adding an ARB does not alter the decline in estimated GFR.

RCTLarge Human TrialHighly Cited

2014·

235citations

·V. Torres et al.

Design of combination angiotensin receptor blocker and angiotensin-converting enzyme inhibitor for treatment of diabetic nephropathy (VA NEPHRON-D).

Combination losartan and lisinopril may slow kidney disease progression in diabetic patients, but its effect on reducing proteinuria remains unclear and may require further study.

Highly Cited

2009·

129citations

·L. Fried et al.

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