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High Blood Pressure

ARB, diuretics and potassium levels

02/26/2008

Question:

I`ve read that ARB`s can increase potassium levels for some people and affect the heart , so is it necessary to get regular tests to check the levels ?

On the other hand I understand that Diuretics decrease the potassium levels. Does this means if you take an ARB and a diuretic you won`t have any imbalances in potassium levels?

Thank you.

Answer:

It is true that angiotensin receptor blockers (ARBs) can increase the blood potassium level.  However, the effect is small and usually not a problem.  High potassium levels with ARBs can occur in patients with kidney disease or in patients who take other medications that can increase potassium.  Such medications include ACE inhibitors, beta blockers, aldosterone antagonists, or certain diuretics (amiloride or triamterene).

You are also correct that most diuretics (thiazides and furosemide)decrease the blood potassium level and are well suited to be combined with ARBs.  The combination usually keeps potassium levels virtually unchanged.  Many ARBs are available as combination pills containing hydrochlorothiazide.

In a person with normal kidney function and not taking other medications that can affect potassium, it is not necessary to recheck the potassium level when starting an ARB.

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Response by:

Max C Reif, MD Max C Reif, MD
Professor of Medicine
Director of Hypertension Section
College of Medicine
University of Cincinnati