Disorders of plasma potassium

2018 ◽  
Author(s):  
Aron Chakera ◽  
William G. Herrington ◽  
Christopher A. O’Callaghan
Keyword(s):  
Serum Potassium ◽  
Potassium Level ◽  
Serum Potassium Level ◽  
Angiotensin Receptor Blockers ◽  
Age Groups ◽  
Renin Angiotensin System ◽  
Plasma Potassium ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Hospitalized Patients ◽  
Converting Enzyme Inhibitors

Potassium is the major intracellular cation, and maintenance of potassium homeostasis is critical for normal cellular function. Serum potassium levels usually range from 3.5–4.5 mmol/l (compared with intracellular levels of ~150 mmol/l). Hypokalaemia is defined as a serum potassium level <3.5 mmol/l, and hyperkalaemia as a serum potassium level >4.5 mmol/l. Hyperkalaemia occurs in over 5% of hospitalized patients, and is most common in older age groups, where it is associated with renal impairment and medication use. Medications that block the renin–angiotensin system, such as angiotensin-converting-enzyme inhibitors and angiotensin receptor blockers, are often responsible. Hypokalaemia is also common, affecting over 15% of hospitalized patients, and is usually related to diuretic use, gastrointestinal losses, or inadequate potassium in the diet. This chapter reviews the causes and management of derangements of plasma potassium.

HFrEF pharmacological treatment: ACEIs and/or ARBs

ESC CardioMed ◽  
2018 ◽  
pp. 1844-1848
Author(s):  
Marc A. Pfeffer
Keyword(s):  
Heart Failure ◽  
Angiotensin Receptor Blockers ◽  
Antihypertensive Agents ◽  
Drug Effects ◽  
Renin Angiotensin System ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme Inhibitors ◽  
Angiotensin System ◽  
Renin Angiotensin ◽  
Reduced Ejection Fraction

Several classes of inhibitors of the renin–angiotensin system were developed as antihypertensive agents. Following the early observations of favourable haemodynamic effects of angiotensin-converting enzyme inhibitors (ACEIs) in patients with congestive heart failure, a series of major randomized outcome trials demonstrated morbidity and mortality benefits of these agents across the spectrum of patients with heart failure with reduced ejection fraction (HFrEF). Angiotensin receptor blockers (ARBs) were then also shown to have similar benefits with a suggestion of some incremental improvements when used together. However, in the trials that randomized patients to a proven dose of an ACEI plus either placebo or an ARB, the combination of the two inhibitors of the renin–angiotensin system resulted in more adverse drug effects without a meaningful improvement in clinical outcomes. This chapter reviews the fundamental underpinnings for use of either an ACEI or ARB to improve prognosis of patients with HFrEF.

scholarly journals Hypertension and angiotensin system inhibitors in patients with metastatic renal cell carcinoma

2016 ◽  
Author(s):  
Lisa Derosa ◽  
Hassane Izzedine ◽  
Laurence Albiges ◽  
Bernard Escudier
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Metastatic Renal Cell Carcinoma ◽  
Renal Cell ◽  
Angiotensin Receptor Blockers ◽  
Treatment Options ◽  
Renin Angiotensin System ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme Inhibitors ◽  
Angiotensin System

Arterial hypertension (HTN) is a class effect of anti-vascular endothelial growth factor (VEGF) therapies, including the monoclonal antibody bevacizumab. Data are conflicting regarding the role of the renin-angiotensin system on angiogenesis and recent data suggest that the use of angiotensin system inhibitors (ASIs; angiotensin receptor blockers or angiotensin-converting enzyme inhibitors) is associated with improved survival in metastatic renal cell carcinoma (mRCC), particularly when used with VEGF targeted therapies. The aim of this review is to discuss the available treatment options for mRCC and associated incidence of hypertension as well as summarize the known data about ASIs use and mRCC. Additionally, given that the optimal management of HTN remains unclear, we will focus on prevention strategies and propose potential therapeutic approaches.

scholarly journals PRESCRIPTION PATTERN OF CARDIOVASCULAR AND/OR ANTIDIABETIC DRUGS IN ABUJA DISTRICT HOSPITALS

2019 ◽  
pp. 21-27
Author(s):  
NKEIRUKA GRACE OSUAFOR ◽  
CHINWE VERONICA UKWE ◽  
MATTEW JEGBEFUME OKONTA
Keyword(s):  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Age Groups ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
World Health ◽  
Channel Blockers ◽  
Converting Enzyme Inhibitors ◽  
Prescribing Indicators ◽  
Prescription Pattern ◽  
District Hospitals

Objective: The study aimed to describe the prescription pattern of cardiovascular and/or anti-diabetic drugs and adherence to the World Health Organization (WHO) prescribing indicators in Abuja District Hospitals. Methods: This descriptive retrospective study was carried out in Asokoro and Maitama District Hospitals Abuja. One thousand and nine prescriptions that contained a cardiovascular drug (CVD) and/or anti-diabetic drug issued between June 2017 and May 2018 from the Medical Outpatient Department were analyzed. Data were collected from the pharmacy electronic database, prescription pattern and adherence to WHO prescribing indicators were assessed. The analysis was done using descriptive statistics. Results were presented as percentages, means, and standard deviations. Results: The frequency of treatment was higher among women (58.8%) and the age group of 41–60 (54.8%). The average number of drugs prescribed was 3.3±1.6: the percentage of drugs prescribed in generic was (64%) and (78.8%) were from the Essential Drug List (EDL). Calcium Channel Blockers (CCB, 71.7%) and Biguanides (B, 92.4%) were the most prescribed CVD and anti-diabetic drug. The majority of the CVD (74.5%) and diabetes (63.6%) patients were on combination therapy. The most frequent CVD combination was CCB plus Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers (29.7%). Compared to men, the proportion of females taking one or more CVD (61.3%) or antidiabetic (56.4%) was higher. Conclusion: The prescribing indicators are not optimal in Abuja district hospitals. Women received more treatment for cardiovascular and diabetes diseases than men while the age range of 41-60 was more treated than other age groups.

scholarly journals Renin-angiotensin system antagonists are associated with lower mortality in hypertensive patients with COVID-19

2020 ◽  
Vol 65 (4) ◽  
pp. 123-126 ◽  
Author(s):  
Michael Megaly ◽  
Mattew Glogoza
Keyword(s):  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Meta Analysis ◽  
Renin Angiotensin System ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Lower Mortality ◽  
Converting Enzyme Inhibitors ◽  
Hypertensive Patients ◽  
Risk Of Death ◽  
Receptor Blockers

The use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) in patients with Coronavirus 2019 (COVID-19) has been controversial. We performed a meta-analysis of all published studies that reported the outcomes of ACEIs/ARBs in patients with COVID-19. We included four observational studies (3,267 patients). The use of ACEIs/ARBs was associated with a similar risk of all-cause death (OR: 0.75, 95% CI [0.36, 1.57], p = 0.45). Sensitivity analysis including only hypertensive patients demonstrated a lower risk of death with ACEIs/ARBs use (OR: 0.57, 95% CI [0.32-0.98], p = 0.04). In conclusion, hypertensive patients with COVID-19 treated with ACEIs/ARBS have a lower mortality but further research is needed.

Effect of non-anticancer drugs on prognosis of pancreatic cancer (PaC) receiving chemotherapy.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 309-309
Author(s):  
Yousuke Nakai ◽  
Hiroyuki Isayama ◽  
Suguru Mizuno ◽  
Takashi Sasaki ◽  
Kazumichi Kawakubo ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Anticancer Drugs ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Locally Advanced ◽  
Renin Angiotensin System ◽  
Progression Free Survival ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme Inhibitors ◽  
Receptor Blockers

309 Background: Non-anticancer drugs such as metformin or statin are reported to have a potential role in cancer treatment and we previously reported inhibition of renin-angiotensin system (RAS) by angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) lead to better prognosis in PaC receiving gemcitabine (Br J Cancer 103: 1644-8). The relation between diabetes (DM) with its medication and the incidence of PaC has been described but its impact on prognosis is still unclear. Methods: We retrospectively reviewed 250 pts with advanced PaC receiving chemotherapy with gemcitabine and/or S-1 between June 2001 and April 2011 with a median follow up of 9.9 months (Mo). Univariate and multivariate analyses of progression-free survival (PFS) and overall survival (OS) were performed in pts with and without DM, using age, gender, BMI, PS, stage, protocol, DM with its treatment, hypertension (HT) with its treatment, and use of statin as variables. Results: DM was diagnosed in 124 pts (49%) and was treated with insulin or insulin analogs (n = 59), sulfonylurea (n = 38), biguanide (n = 8), thiazolidinedione (n = 6), and alpha-glucosidase inhibitor (n = 5). Statin was used in 16 pts with DM and 14 pts without DM. Locally advanced disease (44% vs. 29%) and HT (44% vs. 28%) were more prevalent in pts with DM. PFS (6.3 vs. 4.9 Mo, P = 0.440) and OS (13.3 vs. 10.0 Mo, P = 0.084) was longer in pts with DM, though not significantly. Use of statin in pts with DM was associated with longer PFS (11.6 vs. 6.0 Mo, P = 0.034) and longer OS (25.4 vs. 11.3 Mo, P = 0.006), while PFS and OS did not differ by the use of statin in pts without DM. Multivariate subgroup analysis with and without DM showed metastatic disease (Hazard ratio [HR] 2.11, P = 0.001 and HR 1.57, P = 0.013), PS 0-1 (HR 0.08, P <0.001 and HR 0.21, P <0.001), use of ACEI/ARB (HR 0.60, P = 0.030 and HR 0.46, P = 0.031) as common prognostic factors for OS. Doublet chemotherapy (HR 0.48, P = 0.007) and use of statin (HR 0.40, P = 0.010) were prognostic only in pts with DM, but any medications for DM were not significant prognostic factors. Conclusions: In our retrospective analysis, use of statin in pts with DM as well as inhibition of RAS was associated with better prognosis in pts with PaC receiving chemotherapy.

scholarly journals Renin-Angiotensin System Blockade Improves Cardiac Indices in Acromegaly Patients

2017 ◽  
Vol 125 (06) ◽  
pp. 365-367 ◽  
Author(s):  
Julia Thomas ◽  
Abhishek Dattani ◽  
Filip Zemrak ◽  
Thomas Burchell ◽  
Scott Akker ◽  
...  
Keyword(s):  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Renin Angiotensin System ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Cardiac Effect ◽  
Volume Index ◽  
Converting Enzyme Inhibitors ◽  
Systolic Volume ◽  
End Diastolic Volume ◽  
Cardiac Indices

AbstractBlockade of the angiotensin-renin system, with angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs), has been shown to improve cardiac outcomes following myocardial infarction and delay progression of heart failure. Acromegaly is associated with a disease-specific cardiomyopathy, the pathogenesis of which is poorly understood.The cardiac indices of patients with active acromegaly with no hypertension (Group A, n=4), established hypertension not taking ACEi/ARBs (Group B, n=4) and established hypertension taking ACEi/ARBs (Group C, n=4) were compared using cardiac magnetic imaging.Patients taking ACEi/ARBs had lower end diastolic volume index (EDVi) and end systolic volume index (ESVi) than the other 2 groups ([C] 73.24 vs. [A] 97.92 vs. [B] 101.03 ml/m2, ANOVA p=0.034, B vs. C p<0.01). Groups A and B had EDVi and ESVi values at the top of published reference range values; Group C had values in the middle of the range.Acromegaly patients on ACEi/ARBs for hypertension demonstrate improved cardiac indices compared to acromegaly patients with hypertension not taking these medications. Further studies are needed to determine if these drugs have a beneficial cardiac effect in acromegaly in the absence of demonstrable hypertension.

Abstract 15213: Association of Angiotensin-converting Enzyme Inhibitors or Angiotensin Receptor Blockers Use and Covid-19 Infection Among Patients With Hypertension

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jaejin An ◽  
Rong Wei ◽  
hui zhou ◽  
Tiffany Luong ◽  
Ran Liu ◽  
...  
Keyword(s):  
Antihypertensive Medication ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Age Groups ◽  
Medication Use ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Angiotensin Receptor ◽  
Converting Enzyme Inhibitors ◽  
Increased Risk ◽  
Receptor Blockers

Introduction: Given the limited evidence, we investigated the association between use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) and risk of Covid-19 infection within a large diverse hypertension population. Methods: We identified patients with hypertension as of March 1, 2020 (index date) from Kaiser Permanente Southern California, a large US integrated healthcare system. Patient demographics, antihypertensive medication use, neighborhood income and education, and comorbidities were identified from electronic health records within 1-year pre-index date. The study outcome was a positive RT-PCR test for Covid-19 between March 1 - May 6, 2020. We used multivariable logistic regression models to examine the association between ACEI/ARB use and Covid-19 infection. Results: Among 824,650 patients with hypertension, 16,898 (2.0%) were tested for Covid-19. Of those tested, 1,794 (10.6%) had a positive result and 547 (30.5% of positive cases) were hospitalized within 14-days of testing positive. Of those tested, 4,878 (28.9%) were on ACEIs, 3,473 (20.6%) were on ARBs, and 4,177 (24.7%) were on other antihypertensive medication classes. Risk of covid-19 infection associated with ACEI use decreased with increasing age (P-interaction = 0.01). In age-stratified analyses, ACEI use was not statistically associated with increased risk of Covid-19 infection among the age groups of 18-39, 40-64, and 65-84 years but was associated with lower risk of Covid-19 among those aged ≥85 years ( Table ). Across all age groups, ARB use was not associated with increased risk of Covid-19, but non-white race, lower neighborhood income and education, and no antihypertensive medication use were associated with increased risk of Covid-19. Conclusions: ACEI nor ARB use was not associated with increased risk of Covid-19 infection. The decreased risk of Covid-19 infection among older adults using ACEIs warrants further investigation.

Abstract 17320: Use of Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers and Clinical Outcomes in COVID-19

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michael Pan ◽  
Tariq Azam ◽  
Husam Shadid ◽  
Hanna Berlin ◽  
Chelsea Meloche ◽  
...  
Keyword(s):  
Enzyme Inhibitors ◽  
Clinical Laboratory ◽  
Angiotensin Receptor Blockers ◽  
Kidney Injury ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Protective Role ◽  
Hospitalized Patients ◽  
P Value ◽  
Converting Enzyme Inhibitors ◽  
Artery Disease

Introduction: COVID-19 is caused by infection with SARS-CoV2 which uses ACE2 as its host receptor. RAS inhibitors such as ACE-inhibitors and ARBs (ACEI/ARB) may increase ACE2 levels. ACE2 levels may also have a lung protective role in ARDS. There is concern over the safety of using these medications in patients with COVID-19. Hypothesis: To characterize the association of a history of ACEI/ARB use by hospitalized patients with COVID-19 and with in-hospital outcomes. Methods: The Michigan Medicine Covid-19 Cohort (M 2 C 2 ) is an ongoing prospective observational study in which detailed clinical, laboratory and outcomes data were collected from chart review of consecutive adult patients hospitalized for COVID-19. Patients who were positive for SARS-CoV-2 infection but without symptoms of COVID-19 were not included in this cohort. We identified 490 patients admitted between March 1 st and May 1 st for COVID-19, of whom all 490 had data on whether they took ACEI/ARB prior to hospitalization. We examined the association between ACEI/ARB use and all-cause death, respiratory failure and acute kidney injury (AKI) during their hospitalization. Results: 175 (35.7%) patients were taking ACEI/ARB prior to hospitalization (ACEI/ARB group; mean age 63.6 [SD 13.9]; 64% men) and 315 (64.3%) were not taking ACEI/ARB (non-ACEI/ARB group; median age 58.6 [SD 16.1]; 54.3% men). The risk of developing ARDS was not significantly different between the ACEI/ARB group and non-ACEI/ARB group (47.4% vs 43.5%, p-value 0.53) and neither was the risk death (15.4% vs 16.8%, p-value 0.97), despite a higher prevalence of comorbidities in the ACEI/ARB group including hypertension (96.6% vs 51.4%, p-value <0.001), diabetes mellitus (58.9% vs 34.6%, p-value <0.001), coronary artery disease (22.9% vs 11.4%, p-value 0.002), CHF (16.0% vs 12.1%, p-value 0.26), and CKD (32.0% vs 13.7%, p-value <0.001). Conclusions: Among hospitalized patients with COVID-19, prior to hospitalization use ACEI/ARB was not associated with significantly different risk of ARDS or mortality despite having higher rates of comorbidities in the ACEI/ARB group.

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