Abstract P403: Prevalence And Incidence Of Dyskalemia In Adults With Hypertension Initiating Fixed-dose Combination Treatment Of Telmisartan And Amlodipine In Bangladesh: Findings From The OK Study

Abstract

Introduction. WHO recommends fixed-dose combination (FDC) pills for treating hypertension. All FDC pills include renin-angiotensin inhibitor (RASi) or diuretics and are considered to require blood tests for checking dyskalemia, a significant barrier for implementation in resource-limited settings. However, the need for blood tests may be overemphasized if dyskalemia is uncommon.

Methods. In 2022-2023, a community-based screening program in Dhaka, Bangladesh, recruited adults who were candidates for hypertension treatment (SBP ≥140 and/or DBP > 90 mmHg). We examined the prevalence of dyskalemia, and of those free of prevalent dyskalemia, the incidence of dyskalemia at 2 months of initiating a daily FDC of telmisartan 40mg and amlodipine 5mg. Secondary outcomes were BP change, medication adherence, and symptoms.

Results. Of 1,075 participants (mean age 54 yrs, 71% men, mean baseline BP 157/94 mmHg), hypo- (K <3 mmol/L) and hyperkalemia (>5 mmol/L) were present 1.6% each. Of 1,017 patients without hyperkalemia or creatinine clearance <30 who initiated FDC, 866 had the follow-up blood test. The incidence of hypokalemia (K<3) and hyperkalemia (>5.5) was 1.5% and none, respectively (Figure). Mean SBP change was -29.8 mmHg, 92% self-reported taking the medication every day, and 1% self-reported mild symptoms (e.g., leg swelling). There was one death of undetermined cause.

Conclusions. In Bangladeshi adults with hypertension, the prevalence of dyskalemia was 3.2%. Of those who initiated FDC of telmisartan and amlodipine, 1.5% developed incident hypokalemia and none developed hyperkalemia. Our study suggests that this FDC can be safely used without follow-up blood test.