Department of Cardiology and Vascular Medicine, Faculty of Medicine, Airlangga University, Surabaya, Indonesia.
Acta Med Indones. 2020 Jan;52(1):74-79.
Inhibition of the renin-angiotensin-aldosterone system (RAAS) is a key strategy in treating hypertension in cardiovascular and renal diseases. However, RAAS inhibitors (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, aldosterone receptor antagonists, and direct renin inhibitors) increase the risk of hyperkalemia (serum potassium >5.5 mmol/L). This poses a therapeutic challenge because these patient groups comprise in whom the drugs are therapeutically indicated. Important considerations when initiating ACEI or ARB therapy include obtaining an estimate of glomerular filtration rate and a baseline serum potassium concentration, as well as assessing whether the patient has excessive potassium intake from diet, supplements, or drugs that can also increase serum potassium. Serum potassium monitoring shortly after initiation of therapy can assist in preventing hyperkalemia. If hyperkalemia does develop, prompt recognition of cardiac dysrhythmias and effective treatment to antagonize the cardiac effects of potassium, redistribute potassium into cells, and remove excess potassium from the body is important. Understanding the mechanism of action and monitoring of ACEI and ARB coupled with judicious drug use and clinical vigilance can minimize the risk to the patient of developing hyperkalemia.
抑制肾素-血管紧张素-醛固酮系统（RAAS）是治疗心血管和肾脏疾病中高血压的关键策略。然而，RAAS 抑制剂（血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂、醛固酮受体拮抗剂和直接肾素抑制剂）会增加高钾血症（血清钾>5.5mmol/L）的风险。这给治疗带来了挑战，因为这些患者群体需要这些药物进行治疗。在开始使用 ACEI 或 ARB 治疗时，需要考虑的重要因素包括估计肾小球滤过率和基线血清钾浓度，以及评估患者是否因饮食、补充剂或其他可能导致血清钾升高的药物而摄入过多的钾。在治疗开始后不久监测血清钾有助于预防高钾血症。如果确实发生高钾血症，及时识别心律失常并采取有效措施拮抗钾对心脏的影响、将钾重新分布到细胞内以及从体内清除多余的钾非常重要。了解 ACEI 和 ARB 的作用机制和监测，并结合合理用药和临床警惕性，可以最大限度地降低患者发生高钾血症的风险。
