Junichi Ishigami, Md Mahmudul Hasan, Aruna Sarker, Sharmin Nahar, Sibly Sadik Shuvo, Mir Ishraquzzaman, Mohammad Abdullah Al Mamun, Md Kalimuddin, Sheikh Mohammad Mahbubus Sobhan, Di Zhao, Kunihiro Matsushita, Lawrence J Appel, Sohel Reza Choudhury, Edgar R Miller, Fazila-Tun-Nesa Malik
{"title":"Dyskalemia Prior to and After Initiation of a Fixed Dose Combination of Telmisartan and Amlodipine in Adults with Hypertension in Bangladesh.","authors":"Junichi Ishigami, Md Mahmudul Hasan, Aruna Sarker, Sharmin Nahar, Sibly Sadik Shuvo, Mir Ishraquzzaman, Mohammad Abdullah Al Mamun, Md Kalimuddin, Sheikh Mohammad Mahbubus Sobhan, Di Zhao, Kunihiro Matsushita, Lawrence J Appel, Sohel Reza Choudhury, Edgar R Miller, Fazila-Tun-Nesa Malik","doi":"10.5334/gh.1415","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The World Health Organization recommends fixed-dose combination (FDC) pills for treating hypertension. Antihypertensive FDC pills often contain a renin-angiotensin inhibitor (RASI) or diuretic. Thus, screening and monitoring for dyskalemia (hypokalemia or hyperkalemia) before and after starting these classes of medications are recommended, a significant barrier for implementation in resource-limited settings. However, the need for blood tests may be overemphasized if the prevalence of dyskalemia in patients with hypertension is uncommon and the incidence of dyskalemia is rare after initiation of FDC.</p><p><strong>Methods: </strong>We conducted a community-based blood pressure (BP) screening program in Dhaka, Bangladesh, and determined the prevalence of dyskalemia, as defined by K < 3.0 or K > 5.5 mmol/L, in untreated adults with SBP ≥140 mmHg and/or DBP ≥90 mmHg. Among those with a baseline serum K of ≥3.0 or ≤5.0 mmol/L and creatinine clearance ≥30 ml/min, we determined the incidence of dyskalemia 2 months after initiation of a daily FDC of telmisartan 40 mg and amlodipine 5 mg. Secondary outcomes were BP change, medication adherence, and symptoms.</p><p><strong>Results: </strong>In 2022-2023, we recruited 1,073 adults with SBP ≥140 mmHg and/or DBP ≥90 mmHg. The mean age was 54 years, with 71% men and mean baseline BP 157/94 (SD 12/9.3) mmHg. The prevalence of hypokalemia and hyperkalemia was 1.6% and 0.2%, respectively. FDC was initiated in 1,017 eligible patients, and 864 completed the 2-month follow-up visit. Incident hypokalemia occurred in 1.5% of patients, but there was no case of incident hyperkalemia. The mean change in serum potassium after initiating FDC was -0.05 (0.53) mmol/L. At follow-up, 92% had BP <140/90 mmHg with a mean SBP change of -29.8 mmHg. 1% self-reported mild symptoms (e.g., leg swelling), and there was one death of undetermined cause.</p><p><strong>Conclusions: </strong>Given low prevalence and incidence of hyperkalemia and evident reduction in BP, our study suggests initiating FDC with telmisartan and amlodipine may be a practical and safe option for newly diagnosed hypertension, especially in resource-constrained settings where blood tests cannot be easily obtained.</p>","PeriodicalId":56018,"journal":{"name":"Global Heart","volume":"20 1","pages":"30"},"PeriodicalIF":3.0000,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11927674/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Global Heart","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5334/gh.1415","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: The World Health Organization recommends fixed-dose combination (FDC) pills for treating hypertension. Antihypertensive FDC pills often contain a renin-angiotensin inhibitor (RASI) or diuretic. Thus, screening and monitoring for dyskalemia (hypokalemia or hyperkalemia) before and after starting these classes of medications are recommended, a significant barrier for implementation in resource-limited settings. However, the need for blood tests may be overemphasized if the prevalence of dyskalemia in patients with hypertension is uncommon and the incidence of dyskalemia is rare after initiation of FDC.
Methods: We conducted a community-based blood pressure (BP) screening program in Dhaka, Bangladesh, and determined the prevalence of dyskalemia, as defined by K < 3.0 or K > 5.5 mmol/L, in untreated adults with SBP ≥140 mmHg and/or DBP ≥90 mmHg. Among those with a baseline serum K of ≥3.0 or ≤5.0 mmol/L and creatinine clearance ≥30 ml/min, we determined the incidence of dyskalemia 2 months after initiation of a daily FDC of telmisartan 40 mg and amlodipine 5 mg. Secondary outcomes were BP change, medication adherence, and symptoms.
Results: In 2022-2023, we recruited 1,073 adults with SBP ≥140 mmHg and/or DBP ≥90 mmHg. The mean age was 54 years, with 71% men and mean baseline BP 157/94 (SD 12/9.3) mmHg. The prevalence of hypokalemia and hyperkalemia was 1.6% and 0.2%, respectively. FDC was initiated in 1,017 eligible patients, and 864 completed the 2-month follow-up visit. Incident hypokalemia occurred in 1.5% of patients, but there was no case of incident hyperkalemia. The mean change in serum potassium after initiating FDC was -0.05 (0.53) mmol/L. At follow-up, 92% had BP <140/90 mmHg with a mean SBP change of -29.8 mmHg. 1% self-reported mild symptoms (e.g., leg swelling), and there was one death of undetermined cause.
Conclusions: Given low prevalence and incidence of hyperkalemia and evident reduction in BP, our study suggests initiating FDC with telmisartan and amlodipine may be a practical and safe option for newly diagnosed hypertension, especially in resource-constrained settings where blood tests cannot be easily obtained.
Global HeartMedicine-Cardiology and Cardiovascular Medicine
CiteScore
5.70
自引率
5.40%
发文量
77
审稿时长
5 weeks
期刊介绍：
Global Heart offers a forum for dialogue and education on research, developments, trends, solutions and public health programs related to the prevention and control of cardiovascular diseases (CVDs) worldwide, with a special focus on low- and middle-income countries (LMICs). Manuscripts should address not only the extent or epidemiology of the problem, but also describe interventions to effectively control and prevent CVDs and the underlying factors. The emphasis should be on approaches applicable in settings with limited resources.
Economic evaluations of successful interventions are particularly welcome. We will also consider negative findings if important. While reports of hospital or clinic-based treatments are not excluded, particularly if they have broad implications for cost-effective disease control or prevention, we give priority to papers addressing community-based activities. We encourage submissions on cardiovascular surveillance and health policies, professional education, ethical issues and technological innovations related to prevention.
Global Heart is particularly interested in publishing data from updated national or regional demographic health surveys, World Health Organization or Global Burden of Disease data, large clinical disease databases or registries. Systematic reviews or meta-analyses on globally relevant topics are welcome. We will also consider clinical research that has special relevance to LMICs, e.g. using validated instruments to assess health-related quality-of-life in patients from LMICs, innovative diagnostic-therapeutic applications, real-world effectiveness clinical trials, research methods (innovative methodologic papers, with emphasis on low-cost research methods or novel application of methods in low resource settings), and papers pertaining to cardiovascular health promotion and policy (quantitative evaluation of health programs.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
