ACE and Renal insufficiency: Another critical combination of angiotensin-converting enzyme inhibitors, such as ramipril with potassium salts, and potassium-sparing diuretics, such as spironolactone and potassium salts, might increase the risk of developing hyperkalemia [24], which is likely to be greater in patients with additional risk factors for the development of hyperkalemia (e.g., renal insufficiency).