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ACE Inhibitors & Hyperkalemia : Causes, Symptoms, & Management

Hyperkalemia is a condition when there is an elevated level of potassium in the blood. It can develop as a result of treatment with angiotensin-converting enzyme (ACE) inhibitors. This article explains the mechanism linking ACE inhibitors with hyperkalemia and discusses various management strategies.

What Are ACE Inhibitors?

Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARB) are mainly used for treating hypertension.(1) These are also useful in managing conditions like chronic kidney disease, heart failure, and a few more.

ACE Inhibitors & Hyperkalemia: Exploring the Mechanism

Hyperkalemia can be a life-threatening complication that could result from the use of ACE inhibitors. While ACE inhibitors and ARBs offer numerous benefits, concerns arise due to their potential to cause hyperkalemia and a decline in renal function.(2)

Published incidence estimates of the condition of hyperkalemia linked with ACE inhibitors and ARB vary, however, up to 10% of patients are likely to experience at least mild symptoms of hyperkalemia.(3)

Aldosterone is a hormone that helps in regulating the excretion of potassium in our kidneys through urine. However, ACE inhibitors lower the levels of aldosterone, and this, in turn, promotes potassium retention in the bloodstream and kidneys. This decreases kidney functions and people start experiencing symptoms of general weakness, confusion, muscle cramps, and even severe cardiac arrhythmias.

ACE Inhibitors and Hyperkalemia: Management Strategies

Patients undergoing treatment with angiotensin-converting-enzyme inhibitors or ACE inhibitors start experiencing hyperkalemia after the treatment. The condition might be mild, asymptomatic, and even life-threatening. Hyperkalemia is prominent in patients with pre-existing kidney problems, diabetes, or heart failure.

Managing hyperkalemia is possible by knowing about the severity of symptoms and various approaches or management strategies including adjustment of dosage, restriction of dietary potassium intake, use of oral potassium adsorbent agents, promotion of potassium excretion from the body by using diuretics, and so on.

Below are some of the management strategies for hyperkalemia that might be followed after being treated with ACE inhibitors.

Proper Monitoring

Before initiating ACE inhibitor therapy, doctors advise you to go for kidney function tests. These tests would help them identify patients at increased risk of hyperkalemia and accordingly, they would prescribe low doses in the beginning, and build up the dosage gradually over time while monitoring the levels of potassium in the blood.

Low-potassium Diet  

A low-potassium diet and using diuretics that can increase the elimination of potassium can reduce the incidence of hyperkalemia.

Additionally, restricting the intake of foods rich in potassium is also beneficial in preventing hyperkalemia, and restricting dietary potassium intake is especially essential for patients with renal impairment.(4)


Patients undergoing treatment with angiotensin-converting enzyme (ACE) inhibitors are likely to experience symptoms of hyperkalemia, which could either be mild or life-threatening. That is the reason careful monitoring of the dosage is required. Moreover, prompt recognition and management of the condition will also help in preventing serious complications from the same.


  1. Grassi, D. A. Calhoun, G. Mancia, and R. M. Carey, “Resistant hypertension management: Comparison of the 2017 American and 2018 European High Blood Pressure Guidelines,” Current Hypertension Reports, vol. 21, no. 9, p. 67, 2019. https://doi.org/10.1007/s11906-019-0974-3
  2. BarrattJ, Topham P, Harris K, Oxford Desk Reference. 1st Oxford: Oxford University Press; 2008 Google Scholar https://www.ccjm.org/content/86/9/601#ref-3
  3. Sadjadi SA, McMillan JI, Jaipaul N, Blakely P, Hline SS. A comparative study of the prevalence of hyperkalemia with the use of angiotensin-converting enzyme inhibitors versus angiotensin receptor blockers. Ther Clin Risk Manag. 2009 Jun;5(3):547-52. doi: 10.2147/tcrm.s5176. Epub 2009 Jul 12. PMID: 19707264; PMCID: PMC2710386.
  4. Cupisti A, Kovesdy CP, D’Alessandro C, Kalantar-Zadeh K. Dietary approach to recurrent or chronic hyperkalaemia in patients with decreased kidney function. Nutrients. 2018;10:261. https://doi.org/10.3390/nu10030261
Team PainAssist
Team PainAssist
Written, Edited or Reviewed By: Team PainAssist, Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:August 8, 2023

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