Does Sacubitril/Valsartan Reduce Hyperkalemia in HFrEF Patients Taking MRAs?

A post hoc PARADIGM-HF analysis suggests some benefit, but study limitations make an insufficient case for its preferential use in heart failure patients with reduced ejection fraction taking mineralocorticoid receptor antagonists.

Hyperkalemia is a clinical challenge in patients with heart failure and reduced ejection fraction (HFrEF), because the guideline-recommended regimen includes mineralocorticoid receptor antagonists (MRAs) in addition to renin-angiotensin system inhibitors. In a post hoc analysis of data from the manufacturer-sponsored PARADIGM-HF trial (NEJM JW Cardiol Aug 30 2014; [e-pub] and N Engl J Med 2014 Sep; 371:993), investigators compared the incidence of hyperkalemia in patients with HFrEF treated with sacubitril/valsartan versus enalapril. MRA use was encouraged but at physician discretion.

At baseline, 4671 of 8399 patients were receiving an MRA. Compared with nonrecipients, MRA recipients were younger, had higher potassium levels and more-severe…

Reviewing Author

Frederick A. Masoudi, MD, MSPH, FACC, FAHA

Disclosures

Consultant/Advisory BoardBristol Myers Squibb; CPC Clinical Research

Grant/Research SupportNational Heart, Lung, and Blood Institute

Editorial BoardsUpToDate; American College of Cardiology Self-Assessment Program (SAP)

Leadership Positions in Professional SocietiesAmerican College of Cardiology (Chair, Innovations Committee)