{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T04:58:54Z","timestamp":1785473934854,"version":"3.56.0"},"reference-count":41,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2022,9,30]],"date-time":"2022-09-30T00:00:00Z","timestamp":1664496000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"AstraZeneca"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Whether to continue renin\u2013angiotensin\u2013aldosterone system inhibitor (RAASi) therapy in patients with hyperkalemia remains a clinical challenge, particularly in patients with heart failure (HF), where RAASis remain the cornerstone of treatment. We investigated the incidence of dose reduction or the cessation of RAASis and evaluated the threshold of serum potassium at which cessation alters the risk\u2013benefit balance. Methods: This retrospective analysis of a Japanese nationwide claims database investigated treatment patterns of RAASis over 12 months after the initial hyperkalemic episode. The incidences of the clinical outcomes of patients with RAASi (all ACEi\/ARB\/MRA) or MRA-only cessation (vs. non-cessation) were compared via propensity score-matched patients. A cubic spline regression analysis assessed the hazard of death resulting from treatment cessation vs. no cessation at each potassium level. Results: A total of 5059 hyperkalemic HF patients were identified; most received low to moderate doses of ACEis and ARBs (86.9% and 71.5%, respectively) and low doses of MRAs (76.2%). The RAASi and MRA cessation rates were 34.7% and 52.8% at 1 year post-diagnosis, while the dose reduction rates were 8.4% and 6.5%, respectively. During the mean follow-up of 2.8 years, patients who ceased RAASi or MRA therapies were at higher risk for adverse outcomes; cubic spline analysis found that serum potassium levels of &lt;5.9 and &lt;5.7 mmol\/L conferred an increased mortality risk for RAASi and MRA cessation, respectively. Conclusions: Treatment cessation\/dose reduction of RAASis are common among HF patients. The risks of RAASi\/MRA cessation may outweigh the benefits in patients with mild to moderate hyperkalemia.<\/jats:p>","DOI":"10.3390\/jcm11195828","type":"journal-article","created":{"date-parts":[[2022,10,8]],"date-time":"2022-10-08T23:39:31Z","timestamp":1665272371000},"page":"5828","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Risk\u2013Benefit Balance of Renin\u2013Angiotensin\u2013Aldosterone Inhibitor Cessation in Heart Failure Patients with Hyperkalemia"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3779-2972","authenticated-orcid":false,"given":"Shun","family":"Kohsaka","sequence":"first","affiliation":[{"name":"Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suguru","family":"Okami","sequence":"additional","affiliation":[{"name":"Cardiovascular, Renal, and Metabolism, Medical Affairs, AstraZeneca K.K., Osaka 530-0011, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naru","family":"Morita","sequence":"additional","affiliation":[{"name":"Cardiovascular, Renal, and Metabolism, Medical Affairs, AstraZeneca K.K., Osaka 530-0011, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshitaka","family":"Yajima","sequence":"additional","affiliation":[{"name":"Cardiovascular, Renal, and Metabolism, Medical Affairs, AstraZeneca K.K., Osaka 530-0011, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1159\/000504167","article-title":"Benefits and risks of continuing angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, and mineralocorticoid receptor antagonists during hospitalizations for acute heart failure","volume":"10","author":"Oliveros","year":"2020","journal-title":"Cardiorenal Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1093\/ehjcvp\/pvy015","article-title":"Expert consensus document on the management of hyperkalaemia in patients with cardiovascular disease treated with renin angiotensin aldosterone system inhibitors: Coordinated by the Working Group on Cardiovascular Pharmacotherapy of the European Society of Cardiology","volume":"4","author":"Rosano","year":"2018","journal-title":"Eur. 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