Additional risk factors associated with symptomatic hydrochlorothiazide-induced hyponatremia in hypertensive patients
Abstract
Background. Hydrochlorothiazide is a cheap and effective antihypertensive agent but may cause hyponatremia. Even though several risk factors for hydrochlorothiazide-induced hyponatremia have been reported, this study aimed to evaluate additional risk factors for hydrochlorothiazide-induced hyponatremia in hypertensive patients.
Material and methods. The inclusion criteria were: adult patients, diagnosed with hypertension and receiving hydrochlorothiazide treatment. Eligible patients were divided into two groups: with and without hyponatremia. Those with hyponatremia were identified by using the ICD-10 code E871, while those without hyponatremia were patients who did not have any reported hyponatremia until the last visit. The ratio between hyponatremia and non-hyponatremia group was 1:2. Predictors for hyponatremia were analyzed by using logistic regression analysis.
Results. During the study period, there were 68 patients admitted due to symptomatic hyponatremia from hydrochlorothiazide. There were four independent factors in the model predictive of occurrence of symptomatic hydrochlorothiazide-induced hyponatremia in hypertensive patients: sex, body mass index, plasma glucose, and serum albumin. Male sex, body mass index, and serum albumin were negatively associated with occurrence of symptomatic hydrochlorothiazide-induced hyponatremia in hypertensive patients with adjusted OR of 0.099, 0.683, and 0.122, respectively. The plasma glucose had adjusted OR of 1.030 [95% CI of (1.009, 1.051)].
Conclusions. Factors associated with hydrochlorothiazide-induced symptomatic hyponatremia in hypertensive patients were sex, body mass index, plasma glucose level, and serum albumin level. The latter two risk factors have never been reported as risk factors for hydrochlorothiazide-induced symptomatic hyponatremia in hypertensive patients.
Keywords: predictorsprevalenceplasma glucosealbumin
References
- Chobanian AV, Bakris GL, Black HR, et al. National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, National High Blood Pressure Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003; 289(19): 2560–2572.
- James P, Oparil S, Carter B, et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults. JAMA. 2014; 311(5): 507.
- Wright JT, Probstfield JL, Cushman WC, et al. ALLHAT Collaborative Research Group. ALLHAT findings revisited in the context of subsequent analyses, other trials, and meta-analyses. Arch Intern Med. 2009; 169(9): 832–842.
- Leung AA, Wright A, Pazo V, et al. Risk of thiazide-induced hyponatremia in patients with hypertension. Am J Med. 2011; 124(11): 1064–1072.
- Rodenburg EM, Hoorn EJ, Ruiter R, et al. Thiazide-associated hyponatremia: a population-based study. Am J Kidney Dis. 2013; 62(1): 67–72.
- Huang CC, Chung CM, Hung SI, et al. Clinical and Genetic Factors Associated With Thiazide-Induced Hyponatremia. Medicine (Baltimore). 2015; 94(34): e1422.
- Chow KM, Szeto CC, Kwan BCH, et al. Risk factors for thiazide-induced hyponatraemia. QJM. 2003; 96(12): 911–917.
- Sonnenblick M, Friedlander Y, Rosin AJ. Diuretic-induced severe hyponatremia. Review and analysis of 129 reported patients. Chest. 1993; 103(2): 601–606.
- Hwang KS, Kim GH. Thiazide-induced hyponatremia. Electrolyte Blood Press. 2010; 8(1): 51–57.
- Rastogi D, Pelter MA, Deamer RL. Evaluations of hospitalizations associated with thiazide-associated hyponatremia. J Clin Hypertens (Greenwich). 2012; 14(3): 158–164.
- Rose BD. New approach to disturbances in the plasma sodium concentration. Am J Med. 1986; 81(6): 1033–1040.
- Cooper-DeHoff RM, Bird ST, Nichols GA, et al. Antihypertensive drug class interactions and risk for incident diabetes: a nested case-control study. J Am Heart Assoc. 2013; 2(3): e000125.
- Makam AN, Boscardin WJ, Miao Y, et al. Risk of thiazide-induced metabolic adverse events in older adults. J Am Geriatr Soc. 2014; 62(6): 1039–1045.