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Hyperkalaemia interaction — GPhC CRA MCQ

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HardCardiovascular TherapeuticsHyperkalaemia interactionGPhC CRA

A patient with confirmed resistant hypertension takes ramipril, amlodipine and indapamide at tolerated doses. Clinic BP is 158/94 mmHg, potassium 5.1 mmol/L and eGFR 48 mL/min/1.73 m². They also buy ibuprofen most days. Which recommendation is most consistent with NICE?

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Correct answer: E — Review ibuprofen; avoid potassium-sparing add-on and consider an alpha- or beta-blocker

At step 4, NICE considers low-dose spironolactone only when potassium is 4.5 mmol/L or less and advises particular caution with reduced eGFR. When potassium is above 4.5 mmol/L, consider an alpha- or beta-blocker. Regular NSAID exposure also warrants review because it can worsen BP, renal function and potassium. Amiloride and potassium supplementation intensify risk; dual renin–angiotensin blockade is inappropriate.

Reference: NICE NG136: https://www.nice.org.uk/guidance/ng136/chapter/recommendations