What Happens When ACE Inhibitors and ARBs Are Stopped Because of Hyperkalemia?

When patients who take angiotensin-converting–enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs) develop hyperkalemia, these drugs often are discontinued; this problem is particularly common in patients with impaired renal function. However, important clinical benefits might be lost when ACE inhibitors or ARBs are stopped. Researchers examined this tradeoff in a population-based Canadian study of adults in Manitoba and Ontario who (1) had glomerular filtration rate <60 mL/minute/1.73 m², (2) were taking an ACE inhibitor or an ARB, and (3) developed hyperkalemia (serum potassium level, ≥5.5 mmol/L). Median ages were 74 and 79, respectively, in the two cohorts. Patients on dialysis were excluded.

ACE inhibitors or ARBs were stoppe…