The comparison of losartan and ramipril on the incidence of hyperkalaemia among hypertensive patients with chronic kidney diseaseMohammed Salim Karattuthodi, R. T. Saravana Kumar, Dilip Chandrasekhar
Background and Aims: The Joint National Committee 8th guideline recommends the initiation of renin angiotensin aldosterone system (RAAS)-linked drugs for hypertensive patients with chronic kidney disease (CKD). Losartan, an angiotensin receptor blocker (ARB), and ramipril, angiotensin converting enzyme (ACE) inhibitors, are widely utilized antihypertensive agents with sound efficacy and safety. The study compared the hyperkalemia incidences in CKD patients exposed to losartan and ramipril. Methods: A prospective observational study was conducted for 12 months in the nephrology outpatient setting of a private tertiary care referral hospital in the Malabar region of Kerala. CKD patients with hypertension who were on ACE inhibitors or ARB therapy constituted our study population. Their demographic details, serum creatinine and potassium and urine protein were documented for three consecutive patient consultations. Results: There were an equal number of samples (n=186) in each of the losartan and ramipril administered groups. Losartan and ramipril doses preferred by the nephrologist were 1.25, 25, 50 & 100 mg and 0.625, 1.2, 2.5, 5 and 10 mg, respectively. The Mann-Whitney U test showed statistical significance (p≥0.05) between RAAS-related drugs and patients’ total daily doses. We noticed more frequency of hyperkalemia in the losartan group (n=11, 5.9%) than in the ramipril group (n=4, 2.2%). Initially, the mean serum potassium was low in the ACE inhibitor (4.35±0.55) subset, and then there was augmentation in the second (4.46±0.52) and third (4.52±0.55) patient consultations. The repeated measures ANOVA tests depicted the samples to be different (p<0.05) in the serum potassium measurements within the losartan group (p-=0.018) and ramipril group (p<0.001). Conclusion: Losartan gave favorable clinical effects in CKD patients with regards to serum creatinine and potassium. However, the frequency in reduction of proteinuria was profound in ramipril understudies.