Aims Whether to continue or stop mineralocorticoid receptor antagonists (MRA) after an episode of hyperkalaemia is a challenge in clinical practice. While stopping MRA may prevent recurrent... Show moreAims Whether to continue or stop mineralocorticoid receptor antagonists (MRA) after an episode of hyperkalaemia is a challenge in clinical practice. While stopping MRA may prevent recurrent hyperkalaemias, it deprives patients of their cardioprotection. We here assessed the association between stopping vs. continuingMRA therapy after hyperkalaemia and the subsequent risks of adverse health events.Methods and results Observational study from the Stockholm CREAtinine Measurements (SCREAM) project 2006- 2018. We identified patients initiating MRA and surviving a first-detected episode of hyperkalaemia (plasma potassium >5.0 mmol/L). Using target trial emulation methods, we assessed the association between stopping vs. continuing MRA within 6months after hyperkalaemia and subsequent outcomes. The primary outcome was the composite of hospital admission with heart failure, stroke, myocardial infarction, or death. The secondary outcome was occurrence of another hyperkalaemia event. Among 39 518 patients initiating MRA, we identified 7366 who developed hyperkalaemia. Median age was 76 years, 45% were women and 69% had a history of heart failure. Following hyperkalaemia, 2222 (30%) discontinued treatment. Compared with continuing MRA, stopping therapy was associated with a lower 2-year risk of recurrent hyperkalaemia [hazard ratio (HR) 0.75, 95% confidence interval (CI) 0.72-0.79], but a higher risk of the primary outcome (HR 1.10, 95% CI 1.06-1.14). Similar results were observed in patients with heart failure, after censoring when treatment decision was changed, and across pre-specified subgroups.Conclusions Stopping MRA after an episode of hyperkalaemia was associated with reduced risk for recurrent hyperkalaemia, but higher risk of death or cardiovascular events. Recurrent hyperkalaemia was common in either strategy. Show less
The last decades have shown an increasing interest in treatment of high blood pressure. Copious amounts of data have been published on the mortality and morbidity risks of high blood pressure.... Show moreThe last decades have shown an increasing interest in treatment of high blood pressure. Copious amounts of data have been published on the mortality and morbidity risks of high blood pressure. Overall these data have resulted in an increasing awareness of the deleterious effects of only modest elevation of blood pressure on morbidity and mortality. Moreover, treatment of high blood pressure resulted in substantial benefits in terms of reduced morbidity and mortality. This has resulted in official guidelines about treatment for hypertension that have become stricter with every decade. However, most of the evidence has been generated from middle-aged people. Only a few trials have included people of 80 year and older. [7-9] Looking at the results in detail within that age group the evidence is not robust. Given the increasing lifespan worldwide, physicians are confronted with many elderly patients over eighty. Hence, there is an increasing urge to generate more knowledge in regard to the effects of high blood pressure in the elderly. Show less
