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A comparative study assessing the incidence and degree of hyperkalemia in patients on angiotensin-converting enzyme inhibitors versus angiotensin-receptor blockers


Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin-receptor blockers (ARB) are the most commonly prescribed anti-hypertensive medications in the United States, yet whether ACEI or ARB use is associated with a greater risk of hyperkalemia remains uncertain. Using real-world evidence from electronic health records, our study demonstrates that treatment with ACEI is associated with both a higher incidence and greater degree of hyperkalemia than treatment with ARB in adjusted models, especially in patients with chronic kidney disease. Providers should therefore consider this possible difference in hyperkalemia risk when choosing between ACEI and ARB therapy.

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Dr. McCoy is supported by NINR R21-NR018738.

Author information




JRS was responsible for preparing the manuscript and contributed to the design of the study protocol and data interpretation. SBG was responsible for conducting the data analysis, provided critical review of the manuscript, and contributed to data interpretation. THM was responsible for designing the study protocol, provided critical review of the manuscript, and contributed to data interpretation.

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Correspondence to Jonathan R. Salik.

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The authors declare no competing interests.

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Salik, J.R., Golas, S.B. & McCoy, T.H. A comparative study assessing the incidence and degree of hyperkalemia in patients on angiotensin-converting enzyme inhibitors versus angiotensin-receptor blockers. J Hum Hypertens (2021).

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