Thiazide-associated hyponatremia in arterial hypertension patients: A nationwide population-based cohort study.

Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 101497477 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1756-5391 (Electronic) Linking ISSN: 17565391 NLM ISO Abbreviation: J Evid Based Med Subsets: MEDLINE

Original Publication: Oxford : Wiley-Blackwell

Hyponatremia*/chemically induced ; Hyponatremia*/epidemiology ; Hypertension*/drug therapy ; Thiazides*/adverse effects; Humans ; Female ; Male ; Middle Aged ; Aged ; Republic of Korea/epidemiology ; Cohort Studies ; Risk Factors ; Sodium Chloride Symporter Inhibitors/adverse effects ; Hospitalization/statistics & numerical data ; Adult ; Proportional Hazards Models ; Antihypertensive Agents/adverse effects ; Antihypertensive Agents/therapeutic use

Objective: Thiazides are the first-line treatment for hypertension, however, they have been associated with hospitalizations for thiazide-associated hyponatremia (TAH). The aim of this study was to evaluate the risk of TAH and other drug-associated hyponatremia in a Korean population.
Methods: The study used big data from the National Health Insurance Sharing Service of 1,943,345 adults treated for hypertension from January 2014 to December 2016. The participants were divided into two groups based on the use of thiazides. Cox proportional hazard models were used to identify independent risk factors for the occurrence of hyponatremia.
Results: The study found that hyponatremia-related hospitalizations were significantly higher in the thiazide group than the control group (2.19% vs. 1.45%). The risk increased further with concurrent use of other diuretics or desmopressin, and thiazide+spironolactone+desmopressin and hospitalization risk further increased (4.0 and 6.9 times). Multivariate analysis showed that hyponatremia occurrence increased with age, diabetes mellitus, depression, and thiazide use (hazard ratio = 1.436, p < 0.001). The thiazide group had better 6-year overall survival than the control group but had more fractures and hyponatremia.
Conclusions: Thiazide use is associated with an increased risk of hyponatremia and related complications. However, the mortality rate decreased in those who received thiazides, suggesting that thiazide use itself is not harmful and may help decrease complications and improve prognosis with proper, cautious use in high-risk patients.
(© 2024 The Authors. Journal of Evidence‐Based Medicine published by Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd.)

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Keywords: desmopressin; diuretics; electrolyte; hyponatremia; thiazides

0 (Thiazides)
0 (Sodium Chloride Symporter Inhibitors)
0 (Antihypertensive Agents)

Date Created: 20240403 Date Completed: 20240629 Latest Revision: 20240629

20240630

10.1111/jebm.12601

38566339