Patiromer can provide long-term control of hyperkalemia in patients with resistant hypertension and diabetic kidney disease, according to a study presented at the American Heart Association Scientific Sessions in Orlando.

Murray Epstein, MD, of the University of Miami Leonard M. Miller School of Medicine, and colleagues conducted a post hoc analysis of the 52-week AMETHYST-DN study, which investigated the potassium-lowering effect of patiromer among 306 hypertensive patients with mild and moderate hyperkalemia and diabetic kidney disease on renin-angiotensin-aldosterone system (RAAS) inhibitors. Patients were treated with patiromer in an 8-week initiation phase followed by a 44-week long-term maintenance phase. Seventy-nine patients—64 with mild and 15 with moderate hyperkalemia—had resistant hypertension (baseline systolic BP greater than 140 mmHg on 4 or more classes of antihypertensive medication, including a diuretic) while on RAAS inhibitors. 

At baseline, the 79 patients had a mean (SD) heart rate and systolic and diastolic pressure of 73 (9.9) beats per minute and 156 (10.2) and 83(11.7) mm Hg, respectively. Also at baseline, 51 (65%) of the 79 patients had stage 3b or higher chronic kidney disease. The researchers observed significant decreases in mean serum potassium level at each time point over the 52-week study period. Of the 79 patients, 5 withdrew from the study because of patiromer-related adverse events.

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It is possible that control of serum potassium with patiromer allowed for continuation of RAAS inhibitor therapy and/or maximal RAAS inhibitor dose, according to the investigators.