{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T13:53:57Z","timestamp":1780322037133,"version":"3.54.1"},"reference-count":32,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2012,1,6]],"date-time":"2012-01-06T00:00:00Z","timestamp":1325808000000},"content-version":"vor","delay-in-days":735,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2010,1]]},"abstract":"<jats:p><jats:bold>Study Objective.<\/jats:bold> To identify patient\u2010specific factors associated with spironolactone\u2010induced potassium level elevation in patients with heart failure.<\/jats:p><jats:p><jats:bold>Design.<\/jats:bold> Prospective cohort study.<\/jats:p><jats:p><jats:bold>Setting.<\/jats:bold> Two adult heart failure clinics.<\/jats:p><jats:p><jats:bold>Patients.<\/jats:bold> Sixty\u2010two adult (mean \u00b1 SD age 54 \u00b1 16 yrs) aldosterone antagonist\u2010na\u00efve patients with heart failure.<\/jats:p><jats:p><jats:bold>Intervention.<\/jats:bold> Patients received spironolactone 12.5 mg\/day, titrated to 25 mg\/day if tolerated.<\/jats:p><jats:p><jats:bold>Measurements and Main Results.<\/jats:bold> Blood samples were obtained at baseline, 1 week after spironolactone initiation, and 1 week after spironolactone dose titration for assessment of baseline aldosterone level, serum chemistry, and angiotensinogen (<jats:italic>AGT)<\/jats:italic> c.\u20106G&gt;A and p.M268T and mineralocorticoid receptor (<jats:italic>NR3C2)<\/jats:italic> c.215C&gt;G and p.I180V genotypes. Patient characteristics, laboratory values, and genotypes were compared between those whose potassium levels increased by more than 0.5 mEq\/L (15 patients) and those with lower potassium level elevations (47 patients) after spironolactone initiation and dose titration. Patients with a greater potassium level elevation had a higher mean \u00b1 SD aldosterone concentration (178 \u00b1 92 vs 102 \u00b1 57 pg\/ml, p=0.007) and <jats:italic>NR3C2<\/jats:italic> 215G allele frequency (50% vs 22%, p&lt;0.01). Aldosterone concentrations positively correlated with diuretic dose (r=0.313, p=0.014) and negatively correlated with serum potassium level (r=\u20100.319, p=0.012). On regression analysis, factors predictive of potassium level increases greater than 0.5 mEq\/L with spironolactone were aldosterone level greater than 150 pg\/ml (odds ratio [OR] 30, 95% confidence interval [CI] 3.2\u2013287] and <jats:italic>NR3C2<\/jats:italic> 215G carrier status (OR 17, 95% CI 1.6\u2013167).<\/jats:p><jats:p><jats:bold>Conclusion.<\/jats:bold> Our data suggest that potassium should be monitored with particular caution when spironolactone is started in patients with heart failure who have evidence of elevated aldosterone levels, such as high diuretic requirements, or the <jats:italic>NR3C2<\/jats:italic> 215G allele.<\/jats:p>","DOI":"10.1592\/phco.30.1.1","type":"journal-article","created":{"date-parts":[[2009,12,23]],"date-time":"2009-12-23T09:09:15Z","timestamp":1261559355000},"page":"1-9","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Association of Aldosterone Concentration and Mineralocorticoid Receptor Genotype with Potassium Response to Spironolactone in Patients with Heart Failure"],"prefix":"10.1002","volume":"30","author":[{"given":"Larisa H.","family":"Cavallari","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicki L.","family":"Groo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marlos A. 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