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Publication . Article . 2020

Serum Potassium in the PARADIGM-HF trial

João Pedro Ferreira; Ulrik M. Mogensen; Pardeep S. Jhund; Akshay S. Desai; Jean-Lucien Rouleau; Michael R. Zile; Patrick Rossignol; +4 Authors
Open Access
Published: 18 Aug 2020
Publisher: HAL CCSD
Country: France

Aims: The associations between potassium level and outcomes, the effect of sacubitril–valsartan on potassium level, and whether potassium level modified the effect of sacubitril–valsartan in patients with heart failure and a reduced ejection fraction were studied in PARADIGM‐HF. Several outcomes, including cardiovascular death, sudden death, pump failure death, non‐cardiovascular death and heart failure hospitalization, were examined. Methods and results: A total of 8399 patients were randomized to either enalapril or sacubitril–valsartan. Potassium level at randomization and follow‐up was examined as a continuous and categorical variable (≤3.5, 3.6–4.0, 4.1–4.9, 5.0–5.4 and ≥5.5 mmol/L) in various statistical models. Hyperkalaemia was defined as K+ ≥5.5 mmol/L and hypokalaemia as K+ ≤3.5 mmol/L. Compared with potassium 4.1–4.9 mmol/L, both hypokalaemia [hazard ratio (HR) 2.40, 95% confidence interval (CI) 1.84–3.14] and hyperkalaemia (HR 1.42, 95% CI 1.10–1.83) were associated with a higher risk for cardiovascular death. However, potassium abnormalities were similarly associated with sudden death and pump failure death, as well as non‐cardiovascular death and heart failure hospitalization. Sacubitril–valsartan had no effect on potassium overall. The benefit of sacubitril–valsartan over enalapril was consistent across the range of baseline potassium levels. Conclusions: Although both higher and lower potassium levels were independent predictors of cardiovascular death, potassium abnormalities may mainly be markers rather than mediators of risk for death.

Subjects by Vocabulary

Microsoft Academic Graph classification: Potassium chemistry.chemical_element chemistry Enalapril medicine.drug medicine business.industry business Ejection fraction Confidence interval Hazard ratio Sacubitril, Valsartan Sudden death Internal medicine medicine.medical_specialty Heart failure medicine.disease Cardiology


hyperkalaemia, hypokalaemia, mineralocorticoid receptor antagonists, outcomes, potassium, sacubitril/valsartan, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Cardiology and Cardiovascular Medicine, Aged, Aminobutyrates, Angiotensin Receptor Antagonists, Angiotensin-Converting Enzyme Inhibitors, Biphenyl Compounds, Drug Combinations, Enalapril, Female, Heart Failure, Humans, Male, Randomized Controlled Trials as Topic, Stroke Volume, Valsartan, Ventricular Function, Left, Research Article, Electrolytes, Research Articles, Sacubitril–valsartan