{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T05:41:58Z","timestamp":1787982118918,"version":"build-2784847793"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"24","license":[{"start":{"date-parts":[[2021,5,20]],"date-time":"2021-05-20T00:00:00Z","timestamp":1621468800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Healthcare Research and Quality","award":["R01HS025984"],"award-info":[{"award-number":["R01HS025984"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,12,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Purpose<\/jats:title>\n                  <jats:p>To provide evidence of serum potassium changes in individuals taking angiotensin-converting enzyme inhibitors (ACEIs) and\/or angiotensin receptor blockers (ARBs) concomitantly with spironolactone compared to ACEI\/ARB therapy alone.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>PubMed, Embase, Scopus, and Web of Science were searched for studies including exposure to both spironolactone and ACEI\/ARB therapy compared to ACEI\/ARB therapy alone. The primary outcome was serum potassium change over time. Main effects were calculated to estimate average treatment effect using random effects models. Heterogeneity was assessed using Cochran\u2019s Q and I2. Risk of bias was assessed using the revised Cochrane risk of bias tool.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>From the total of 1,225 articles identified, 20 randomized controlled studies were included in the meta-analysis. The spironolactone plus ACEI\/ARB group included 570 patients, while the ACEI\/ARB group included 547 patients. Treatment with spironolactone and ACEI\/ARB combination therapy compared to ACEI\/ARB therapy alone increased the mean serum potassium concentration by 0.19 mEq\/L (95% CI, 0.12-0.26 mEq\/L), with intermediate heterogeneity across studies (Q statistic = 46.5, P = 0.004; I2 = 59). Sensitivity analyses showed that the direction and magnitude of this outcome did not change with the exclusion of individual studies, indicating a high level of reliability. Reporting risk of bias was low for 16 studies (80%), unclear for 3 studies (15%) and high for 1 study (5%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Treatment with spironolactone in combination with ACEI\/ARB therapy increases the mean serum potassium concentration by less than 0.20 mEq\/L compared to ACEI\/ARB therapy alone. However, serum potassium and renal function must be monitored in patients starting combination therapy to avoid changes in serum potassium that could lead to hyperkalemia.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ajhp\/zxab215","type":"journal-article","created":{"date-parts":[[2021,5,20]],"date-time":"2021-05-20T01:28:36Z","timestamp":1621474116000},"page":"2245-2255","source":"Crossref","is-referenced-by-count":9,"title":["Serum potassium changes due to concomitant ACEI\/ARB and spironolactone therapy: A systematic review and meta-analysis"],"prefix":"10.1093","volume":"78","author":[{"given":"Lorenzo","family":"Villa-Zapata","sequence":"first","affiliation":[{"name":"Department of Pharmacy Practice, College of Pharmacy, Mercer University, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Briggs S","family":"Carhart","sequence":"additional","affiliation":[{"name":"Geisel School of Medicine, Dartmouth College, Hanover, NH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John R","family":"Horn","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice, School of Pharmacy, University of Washington, Seattle, WA"},{"name":"Pharmacy Services, UW Medicine, Seattle, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip D","family":"Hansten","sequence":"additional","affiliation":[{"name":"School of Pharmacy, University of Washington, Seattle, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vignesh","family":"Subbian","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering and Department of Systems & Industrial Engineering, College of Engineering, The University of Arizona, Tucson, AZ, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheila","family":"Gephart","sequence":"additional","affiliation":[{"name":"Community and Health Systems Science, College of Nursing, The University of Arizona, Tucson, AZ, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malinda","family":"Tan","sequence":"additional","affiliation":[{"name":"College of Pharmacy, L.S. 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