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Volume 351:2450-2451 December 2, 2004 Number 23
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Hyperkalemia and Inhibitors of the Renin–Angiotensin–Aldosterone System

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by Palmer, B. F.
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To the Editor: In his excellent review, Palmer (Aug. 5 issue)1 discusses strategies for minimizing the incidence and degree of hyperkalemia in patients taking inhibitors of the renin–angiotensin–aldosterone system.2 One strategy he does not suggest is earlier initiation of therapy. The cardioprotective effects of aldosterone antagonists and the renoprotective effects of angiotensin-converting–enzyme (ACE) inhibitors (and angiotensin-receptor blockers) in patients with advanced disease have become clear. Earlier initiation of treatment, before the glomerular filtration rate and the ability to secrete potassium begin to decrease, would both slow the progression of disease and minimize the development of hyperkalemia. It is therefore tempting . . . [Full Text of this Article]



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