The Significance of Angiotensin Converting Enzyme Inhibitor or Angiotensin II Receptor Blocker Use in Sudden Cardiac Death — Oak Academic Publishing
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The Significance of Angiotensin Converting Enzyme Inhibitor or Angiotensin II Receptor Blocker Use in Sudden Cardiac Death
Division of Critical Care Medicine, Department of Critical Care, Disaster and General Medicine, School of Medicine, Iwate Medical University, Morioka, Japan
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Division of Critical Care Medicine, Department of Critical Care, Disaster and General Medicine, School of Medicine, Iwate Medical University, Morioka, Japan
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Division of Critical Care Medicine, Department of Critical Care, Disaster and General Medicine, School of Medicine, Iwate Medical University, Morioka, Japan
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Division of Critical Care Medicine, Department of Critical Care, Disaster and General Medicine, School of Medicine, Iwate Medical University, Morioka, Japan
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Division of Critical Care Medicine, Department of Critical Care, Disaster and General Medicine, School of Medicine, Iwate Medical University, Morioka, Japan
1 Division of Critical Care Medicine, Department of Critical Care, Disaster and General Medicine, School of Medicine, Iwate Medical University, Morioka, Japan
2 Division of Critical Care Medicine, Department of Critical Care, Disaster and General Medicine, School of Medicine, Iwate Medical University, Morioka, Japan
3 Division of Critical Care Medicine, Department of Critical Care, Disaster and General Medicine, School of Medicine, Iwate Medical University, Morioka, Japan
4 Division of Critical Care Medicine, Department of Critical Care, Disaster and General Medicine, School of Medicine, Iwate Medical University, Morioka, Japan
5 Division of Critical Care Medicine, Department of Critical Care, Disaster and General Medicine, School of Medicine, Iwate Medical University, Morioka, Japan
Objectives: To investigate the relationship between the use of angiotensin converting enzyme (ACE) inhibitor or angiotensin II receptor blocker (ARB) and hyperkalemia in patients diagnosed with sudden cardiac death. Methods: We examined oral ACE inhibitor or ARB use among cardiopulmonary arrest patients brought by ambulance to our emergency room during a 5-year period from January 2012 to December 2016. The cause of death was determined to be sudden cardiac death, despite temporary return of spontaneous circulation after starting cardiopulmonary resuscitation. Subjects were dichotomized into 2 groups, those taking and those not taking an ACE inhibitor or ARB. Variables determined retrospectively included serum potassium, estimated glomerular filtration rate as an index of kidney function and time from cardiopulmonary arrest to return of spontaneous circulation. The Mann-Whitney U-test was used to compare continuous data, and the chi-square test to compare categorical data between groups. The results are expressed as the median plus range. Statistical significance was assumed at p < 0.05. Results: Thirty-five patients met the inclusion criteria. The mean age was 77.1 years (range, 35 - 93 years), and there were 26 males and 9 females. Eleven subjects were ACE inhibitor or ARB users, and 24 were non-users. The serum potassium level was significantly higher in users than non-users (median, 6.2 mEq/L (range, 4.5 - 10.0) vs. 5.2 mEq/L (range, 3.6 - 8.3); p = 0.001). The estimated glomerular filtration rate was significantly lower in users than non-users (median, 25.1 mL/min/1.73 m 2 (range, 4.6 - 60.3) vs. 46.9 mL/min/1.73 m 2 (range, 19.8 - 97.1); p = 0.009). There was no significant difference in time from cardiopulmonary arrest to return of spontaneous circulation between the 2 groups (median, 24 minutes (range, 3 - 111) vs. 29 minutes (range, 10 - 54); p = 0.355). Conclusion: It is possible that hyperkalemia induced by ACE inhibitor or ARB use is a cause of sudden cardiac death, especially in patients with chronic kidney disease.
KeywordsAngiotensin Converting Enzyme InhibitorsAngiotensin II Receptor BlockersGlomerular Filtration RateHyperkalemiaSudden Cardiac Death
Ahuja, T.S., Freeman, D.J., Mahnken, J.D., Agraharkar, M., Siddiqui, M. and Memon, A. (2000) Predictors of the Development of Hyperkalemia in Patients Using Angiotensin-Converting Enzyme Inhibitors. American Journal of Nephrology, 20, 268-272. https://doi.org/10.1159/000013599
Palmer, B.F. (2003) Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers: What to Do if the Serum Creatinine and/or Serum Potassium Concentration Rises. Nephrology Dialysis Transplantation, 18, 1973-1975. https://doi.org/10.1093/ndt/gfg282
Raebel, M.A. (2012) Hyperkalemia Associated with Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers. Cardiovascular Therapeutics, 30, e156-e166. https://doi.org/10.1111/j.1755-5922.2010.00258.x http://onlinelibrary.wiley.com/doi/10.1111/j.1755-5922.2010.00258.x/abstract
Ramesh, S., Zalucky, A., Hemmelgarn, B.R., Roberts, D.J., Ahmed, S.B., Wilton, S.B. and Jun, M. (2016) Incidence of Sudden Cardiac Death in Adults with End-Stage Renal Disease: A Systematic Review and Meta-Analysis. BMC Nephrology, 17, 78. https://doi.org/10.1186/s12882-016-0293-8 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940956/
Levey, A.S., Inker, L.A. and Coresh, J. (2014) GFR Estimation: From Physiology to Public Health. American Journal of Kidney Diseases, 63, 820-834. https://doi.org/10.1053/j.ajkd.2013.12.006
Matsuo, S., Imai, E., Horio, M., Yasuda, Y., Tomita, K., Nitta, K., Yamagata, K., Tomino, Y., Yokoyama, H. and Hishida, A. (2009) Revised Equations for Estimated GFR from Serum Creatinine in Japan. American Journal of Kidney Diseases, 53, 982-992. https://doi.org/10.1053/j.ajkd.2008.12.034
Yusuf, S., Teo, K.K., Pogue, J., Dyal, L., Copland, I., Schumacher, H., Dagenais, G., Sleight, P. and Anderson, C. (2008) Telmisartan, Ramipril, or Both in Patients at High Risk for Vascular Events. The New England Journal of Medicine, 358, 1547-1559. https://doi.org/10.1056/NEJMoa0801317
Erden, I., Yalcin, S. and Ozhan, H. (2010) Syncope Caused by Hyperkalemia during Use of a Combined Therapy with the Angiotensin-Converting Enzyme Inhibitor and Spironolactone. Kardiologia Polska, 68, 1043-1046.
Sadjadi, S.A., McMillan, J.I., Jaipaul, N., Blakely, P. and Hline, S.S. (2009) A Comparative Study of the Prevalence of Hyperkalemia with the Use of Angiotensin-Converting Enzyme Inhibitors versus Angiotensin Receptor Blockers. Therapeutics and Clinical Risk Management, 5, 547-552.
Fujii, H., Nakahama, H., Yoshihara, F., Nakamura, S., Inenaga, T. and Kawano, Y. (2005) Life-Threatening Hyperkalemia during a Combined Therapy with the Angiotensin Receptor Blocker Candesartan and Spironolactone. Kobe Journal of Medical Sciences, 51, 1-6.
Johnston, R.T., De Bono, D.P. and Nyman, C.R. (1992) Preventable Sudden Death in Patients Receiving Angiotensin Converting Enzyme Inhibitors and Loop/Potassium Sparing Diuretic Combinations. International Journal of Cardiology, 34, 213-215. https://doi.org/10.1016/0167-5273(92)90159-Z
Froilán Torres, C., Castro Carbajo, P., Pajares Villarroya, R., Plaza Santos, R., Gómez Senent, S., Martín Arranz, M.D., Adán Merino, L., Martín Arranz, E., Manceñido Marcos, N., Peces, R. and Benito López, D. (2009) Acute Spontaneous Tumor Lysis Syndrome in a Patient with Crohn’s Disease Taking Immunosuppressants. Revista Espanola de Enfermedades Digestivas, 101, 288-294.
Jeha, S. (2001) Tumor Lysis Syndrome. Seminars in Hematology, 38, 4-8. https://doi.org/10.1016/S0037-1963(01)90037-X
Mann, J.F., Schmieder, R.E., McQueen, M., Dyal, L., Schumacher, H., Pogue, J., Wang, X., Maggioni, A., Budaj, A., Chaithiraphan, S., Dickstein, K., Keltai, M., Metsärinne, K., Oto, A., Parkhomenko, A., Piegas, L.S., Svendsen, T.L., Teo, K.K. and Yusuf, S. (2008) Renal Outcomes with Telmisartan, Ramipril, or both, in People at High Vascular Risk (the ONTARGET Study): A Multicentre, Randomised, Double-Blind, Controlled Trial. The Lancet, 372, 547-553. https://doi.org/10.1016/S0140-6736(08)61236-2 http://www.sciencedirect.com/science/article/pii/S0140673608612362?via%3Dihub
Cittanova, M.L., Zubicki, A., Savu, C., Montalvan, C., Nefaa, N., Zaier, K., Riou, B. and Coriat, P. (2001) The Chronic Inhibition of Angiotensin-Converting Enzyme Impairs Postoperative Renal Function. Anesthesia & Analgesia, 93, 1111-1115. https://doi.org/10.1097/00000539-200111000-00008
Lim, H.J., Lee, H.H., Kim, A.J., Ro, H., Kim, H.S., Chang, J.H., Chung, W. and Jung, J.Y. (2016) Renin-Angiotensin-Aldosterone System Blockade in Critically Ill Patients Is Associated with Increased Risk for Acute Kidney Injury. The Tohoku Journal of Experimental Medicine, 238, 17-23. https://doi.org/10.1620/tjem.238.17
Brenner, B.M., Cooper, M.E., De Zeeuw, D., Keane, W.F., Mitch, W.E., Parving, H.H., Remuzzi, G., Snapinn, S.M., Zhang, Z. and Shahinfar, S. (2001) Effects of Losartan on Renal and Cardiovascular Outcomes in Patients with Type 2 Diabetes and Nephropathy. The New England Journal of Medicine, 345, 861-869. https://doi.org/10.1056/NEJMoa011161
Lewis, E.J., Hunsicker, L.G., Clarke, W.R., Berl, T., Pohl, M.A., Lewis, J.B., Ritz, E., Atkins, R.C., Rohde, R. and Raz, I. (2001) Renoprotective Effect of the Angiotensin-Receptor Antagonist Irbesartan in Patients with Nephropathy Due to Type 2 Diabetes. The New England Journal of Medicine, 345, 851-860. https://doi.org/10.1056/NEJMoa011303
Atkins, R.C., Briganti, E.M., Lewis, J.B., Hunsicker, L.G., Braden, G., Champion de Crespigny, P.J., De Ferrari, G., Drury, P., Locatelli, F., Wiegmann, T.B. and Lewis, E.J. (2005) Proteinuria Reduction and Progression to Renal Failure in Patients with Type 2 Diabetes Mellitus and Overt Nephropathy. American Journal of Kidney Diseases, 45, 281-287. https://doi.org/10.1053/j.ajkd.2004.10.019
Maschio, G., Alberti, D., Locatelli, F., Mann, J.F., Motolese, M., Ponticelli, C., Ritz, E., Janin, G. and Zucchelli, P. (1999) Angiotensin-Converting Enzyme Inhibitors and Kidney Protection: The AIPRI Trial. The ACE Inhibition in Progressive Renal Insufficiency (AIPRI) Study Group. Journal of Cardiovascular Pharmacology, 33, S16-S20, S41-S43. https://doi.org/10.1097/00005344-199900001-00004
Lewis, E.J. (2007) Treating Hypertension in the Patient with Overt Diabetic Nephropathy. Seminars in Nephrology, 27, 182-194. https://doi.org/10.1016/j.semnephrol.2007.01.005
Weinberg, J.M., Appel, L.J., Bakris, G., Gassman, J.J., Greene, T., Kendrick, C.A., Wang, X., Lash, J., Lewis, J.A., Pogue, V., Thornley-Brown, D., Phillips, R.A. and African American Study of Hypertension and Kidney Disease Collaborative Research Group (2009) Risk of Hyperkalemia in Nondiabetic Patients with Chronic Kidney Disease Receiving Antihypertensive Therapy. Archives of Internal Medicine, 169, 1587-1594. https://doi.org/10.1001/archinternmed.2009.284
Amir, O., Hassan, Y., Sarriff, A., Awaisu, A., Abd Aziz, N. and Ismail, O. (2009) Incidence of Risk Factors for Developing Hyperkalemia When Using ACE Inhibitors in Cardiovascular Diseases. Pharmacy World & Science, 31, 387-393. https://doi.org/10.1007/s11096-009-9288-x
Maddirala, S., Khan, A., Vincent, A. and Lau, K. (2008) Effect of Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers on Serum Potassium Levels and Renal Function in Ambulatory Outpatients: Risk Factors Analysis. The American Journal of the Medical Sciences, 336, 330-335. https://doi.org/10.1097/MAJ.0b013e3181836ac7