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Abstract
Thirty-three hypertensive patients with a wide range of renal function were studied
during initiation of angiotensin-converting enzyme inhibition with captopril to evaluate
changes in potassium levels concomitant with reduction of aldosterone excretion. Ten
patients (Group I) with low levels of plasma renin activity had no change in either
aldosterone excretion or potassium during the first week of therapy. Twenty-three
other patients (Group II) had decreased aldosterone excretion of an average of 63
percent, often reversing secondary hyperaldosteronism. This was associated with a
rise in serum potassium from 3.6 ± 0.1 to 4.4 ± 0.1 mEq/liter (p < 0.001). Serum potassium
levels during captopril therapy were inversely related to glomerular filtration rate
(creatinine clearance) and transiently exceeded 6.0 mEq/liter in markedly azotemic
subjects. Despite rising potassium levels, nine patients had reduced aldosterone excretion
to subnormal levels, sometimes for many months. During initiation of converting-enzyme
inhibition, potassium-sparing agents and supplements should be discontinued and serum
potassium levels should be monitored closely, particularly in patients with impaired
renal function.
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Article Info
Publication History
Accepted:
May 12,
1982
Footnotes
☆Portions of this work were presented at the 13th Annual Meeting of the American Society of Nephrology, Washington, D.C., November 23–25, 1980.
Identification
Copyright
© 1982 Published by Elsevier Inc.
