Article date: November 2017
By: Fawaz F. Alharbi, Patrick C. Souverein, Mark C. H. Groot, Marieke T. Blom, Anthonius Boer, Olaf H. Klungel, Hanno L. Tan in Volume 83, Issue 11, pages 2541-2548
Aims
Sudden cardiac arrest (SCA) is a complex multifactorial event and most commonly caused by ventricular tachycardia/ fibrillation (VT/ VF). Some antihypertensive drugs could induce hypokalaemia or hyperkalaemia, which may increase susceptibility to VT/VF and SCA.
Objective
To assess the association between different classes of antihypertensive drugs classified according to their potential impact on serum potassium levels and the occurrence of out‐of‐hospital cardiac arrest (OHCA) based on VT/VF.
Methods
A case–control study was performed among current users of antihypertensive drugs. Cases were OHCA victims with electrocardiogram documented VT/VF drawn from the AmsteRdam REsuscitation STudies (ARREST) registry, and controls were non‐OHCA individuals from the PHARMO database. Antihypertensive drugs were classified into: (i) antihypertensives with neutral effect on serum potassium levels; (ii) hypokalaemia‐inducing antihypertensives; (iii) hyperkalaemia‐inducing antihypertensives; (iv) combination of antihypertensives with hypo‐ and hyperkalaemic effects.
Results
We included 1345 cases and 4145 controls. The risk of OHCA was significantly increased among users of hypokalaemia‐inducing antihypertensives [adjusted odds ratio (OR) 1.39; 95% confidence interval (CI) 1.10–1.76] and among users of a combination of antihypertensives with hypo‐ and hyperkalaemic effects (adjusted OR 1.42; 95%CI 1.17–1.72) vs. users of antihypertensives with neutral effect. There was no difference in OHCA risk between users of hyperkalaemia‐inducing antihypertensives vs. users of antihypertensive drugs with neutral effect (adjusted OR 1.15; 95%CI 0.95–1.40).
Conclusion
The risk of OHCA is significantly increased in patients who were current users of hypokalaemia‐inducing antihypertensives and patients using a combination of antihypertensives with hypo‐ and hyperkalaemic effects.
DOI: 10.1111/bcp.13356
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