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Does Lisinopril Cause Increased Potassium Levels?

Posted on Mon, 26 May 2014

Question: Hello. In 2011 I had a nephroureterectomy due to transitional cell carcinoma of the kidney. Then my blood pressure became high enough to be considered Stage II Hypertension; my doctor prescribed Plendil then added Lisinopril. The blood pressure has come down (not the 120/80 that I'd always been before the surgery, but it's better). My yearly physical is every three or four months anymore. On Monday I had blood work for my visit to my doctor next week. He called me two hours afterward (well, the nurse called) and told me that the Potassium level is 6.2; stop taking the Lisinopril; he called in a prescription for Kayexalate
(sodium polystyrene sulfonate) and to take it immediately then repeat the blood work at the end of the week. I try not to be paranoid but after having the (what seemed) the entire left side of my insides removed and the catheter for a month and everything else, I sometimes do; and researching the internet on my own isn't any help either. Do you think this sounds like the blood pressure medication; or the beginnings of renal failure?

Thank you
XXXX

Answered by Dr. Dr. Rovena (3 hours later)

Brief Answer:
More likely it is a side effect of Lisinopril.

Detailed Answer:
Hello XXXX

I had gone through your query and understand your concern.

Lisinopril is an angiotensin converting enzyme (ACE) inhibitor used for treating high blood pressure.
ACE inhibitors such as lisinopril lower blood pressure by inhibiting the action of one enzyme called ACE,and this consequently reduce the production of angiotensin II.This leads to reduction of Aldosteron production.
Aldosteron acts on the distal tubules and collecting ducts of the kidney increasing absorption of ions and water in the kidney, to cause the conservation of sodium, secretion of potassium.
When Lisinopril is used Aldosteron production is reduced and this leads to sodium secretions and potassium conservation.

That's the reason that a major side effect of ACE inhibitors (including Lisinopril) is increasing levels of potassium in the blood.

I think that your elevated level of potassium in blood is due to Lisinopril intake.
If your blood test including blood urea and creatinine are in normal range your kidney is fine and it is working properly because the concentration of creatinine and urea in your blood correlates inversely with your kidney function: If kidney function declines, serum creatinine and urea rises. Thus, kidney function can be estimated from a routine measurement of creatinine and urea in your blood.

You don't need to worry.The doctor has prescribed you the right treatment to reduce increased Potassium.
Follow rigorously his directions.

Hope my answer has clarified your doubts.
If you have further questions please feel free to write me,I will be happy to help.
Take care
Dr.Rovena

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Dr. Rovena (23 hours later)

Thank you Dr. Rovena.

I totally trust my doctor and his advice. (After all he's gone through with me ... HE is the one who noticed a problem in November of 2010 during a routine yearly physical; and everything that followed.) The nurse did not mention elevated creatinine (which I've asked about in the past) and she didn't mention anything about sugar or protein in the urine; just the potassium.

I guess I get nervous and worried; I know what happened the last time he called me the day of blood-work. Okay, maybe I am a "nervous Nelly" but it's often difficult NOT to be.

I really appreciate your answering and your opinion. I do feel better that the potassium increase is probably due to the Lisinopril. Please don't misunderstand, I DO trust my doctor (he seems to worry about me more than I do); but I do get a bit scared; until 2010 I'd always been healthy, never a problem, one physical a year and "see ya' till next year".

One more question, if you don't mind; without the Lisinopril, what about the high blood pressure? Obviously Plendil alone wasn't doing it; otherwise he wouldn't have added the Lisinopril. Before Lisinopril blood pressure was around 181/107 (sometimes higher). The last time I took my blood pressure it was 145/89 (not so bad I guess with one kidney.) I know blood pressure is controlled by kidneys and high blood pressure is a big problem for the heart and kidneys. Is this going to be an "on again - off again" with blood pressure medication? Is it as serious and horrible as I seem to be making it out to be?

I so appreciate your advice and taking the time to listen to me, Dr. Rovena.

Thank you.
XXXX

Answered by Dr. Dr. Rovena (32 minutes later)

Brief Answer:
Please read the detailed answer below.

Detailed Answer:
Hello again XXXX
I am glad to know that my answer served for you to feel better.

I totally understand your preoccupation for your health,you have gone through a lot.If I were in your place probably I would be as concerned as you.
I really appreciate the fact that you trust completely your doctor because you both are fighting the same war,the one against your disease and without trust get difficult to win this fight.

About your question,Yes it is very important to control your blood pressure and try to keep it as near as possibly to the normal range.
The number 145/89 isn't considered a high blood pressure.
For now you just need to monitor your blood pressure.Try to measure it twice a day every day.
These numbers are very useful to your treating doctor to decide if you need to add a drug to your anti-hypertensive therapy.

If your blood pressure stay high (over 140/85) for most of the days than you probably need to take another drug apart Plendil to keep your blood pressure in normal values.

You don't need to worry because in this case your doctor will prescribe you a drug that doesn't has side effect that can damage your kidney or do not elevate potassium level in blood.(so a drug that is appropriate for your condition).

Hope my answer has clarified your doubts.
If you have further questions please don't hesitate to write me.
Wish you good health.Good luck.

Dr.Rovena

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Dr. Rovena (24 hours later)

Dr. Rovena

Thank you so much for this. I do feel a bit better about this "unknown" that has slapped me in the face. I do monitor my blood pressure (with both arm and wrist cuff monitors) and give them to my doctor at each visit.

I so appreciate your time and advice. Tomorrow I have blood work again.

XXXX

Answered by Dr. Dr. Rovena (8 hours later)

Brief Answer:
Good luck!

Detailed Answer:
Dear Mr XXXXXXX

I am glad you feel better about this.
It was my pleasure answering your questions and make you feel more comfortable.

I wish you a good health and always keep believing that good thing will happen to you.

God bless you and Take care.

Dr.Rovena

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Above answer was peer-reviewed by : Dr. Prasad