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Risk of Thiazide-induced Hyponatremia in Patients with Hypertension

Abstract:Background:Although hyponatremia is a well-recognized complication of treatment with thiazide diuretics,the risk of thiazide-induced hyponatremia remains uncertain in routine care.Methods:We conducted a retrospective cohort study using a multicenter clinical research registry to identify 2613 adult outpatients that were newly treated for hypertension between January 1,2000 and December 31,2005 at 2 teaching hospitals in Boston,Massachusetts,and followed them for up to 10 years.Results:Two hundred twenty patients exposed to ongoing thiazide therapy were compared with 2393 patients who were not exposed. In the exposed group,66 (30%) developed hyponatremia (sodium ≤130 mmol/L). The adjusted incidence rate of hyponatremia was 140 cases per 1000 person-years for patients treated with thiazides,compared with 87 cases per 1000 person-years in those without thiazides. Patients exposed to thiazides were more likely to develop hyponatremia (adjusted incidence rate ratio,1.61;95% confidence interval [CI],1.15-2.25). There was no significant difference in the risk of hospitalizations associated with hyponatremia (adjusted rate ratio,1.04;95% CI,0.46-2.32) or mortality (adjusted rate ratio,0.41;95% CI,0.12-1.42). The number needed to harm (to result in one excess case of incident hyponatremia in 5 years) was 15.02 (95% CI,7.88-160.30).Conclusions:Approximately 3 in 10 patients exposed to thiazides who continue to take them develop hyponatremia.
The American Journal of Medicine

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