Risk of hyponatremia with diuretics: chlorthalidone versus hydrochlorothiazide.

Autor:	van Blijderveen JC; Department of Medical Informatics, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands. Electronic address: j.vanblijderveen@erasmusmc.nl., Straus SM; Department of Medical Informatics, Erasmus Medical Center, Rotterdam, the Netherlands; Dutch Medicines Evaluation Board, Utrecht, the Netherlands., Rodenburg EM; Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands., Zietse R; Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands., Stricker BH; Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands; Drug Safety Unit, Inspectorate of Healthcare, The Hague, the Netherlands., Sturkenboom MC; Department of Medical Informatics, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands., Verhamme KM; Department of Medical Informatics, Erasmus Medical Center, Rotterdam, the Netherlands.
Jazyk:	angličtina
Zdroj:	The American journal of medicine [Am J Med] 2014 Aug; Vol. 127 (8), pp. 763-71. Date of Electronic Publication: 2014 May 05.
DOI:	10.1016/j.amjmed.2014.04.014
Abstrakt:	Background: Chlorthalidone and hydrochlorothiazide are often considered as interchangeable. However, greater (nighttime) blood pressure reduction, and alleged pleiotropic effects have renewed the interest in chlorthalidone. A recent study showed an increased risk of adverse events with chlorthalidone, including hyponatremia. Methods: To investigate differences in risk of hyponatremia between chlorthalidone and hydrochlorothiazide, adjusted for daily dose, we conducted a population-based case-control study within the Dutch IPCI (Integrated Primary Care Information) database. The study population included all subjects ≥18 years without diabetes mellitus, heart failure, liver failure, and malignancy, who were registered in the IPCI database from 1996 to 2011. Cases were subjects with a serum sodium <130 millimoles per liter or hospitalization due to hyponatremia. Controls were matched on practice, age within 5 years, sex, and date of onset. Results: A total of 1033 cases of hyponatremia were identified. Hyponatremia was more common with chlorthalidone than with hydrochlorothiazide at equal dose per day: adjusted odds ratio was 2.09 (95% confidence interval [CI], 1.13-3.88) for 12.5 milligrams per day and 1.72 (95% CI, 1.15-2.57) for 25 milligrams per day. Risks were not significantly increased with chlorthalidone compared with twice the dose per day of hydrochlorothiazide. Conclusions: This is the first study that shows an increased risk of hyponatremia with chlorthalidone relative to hydrochlorothiazide at equal milligram-to-milligram dose per day. The need for a lower dose of chlorthalidone than hydrochlorothiazide to achieve similar blood pressure reduction likely compensates for the increased risk of hyponatremia at equal dose. (Copyright © 2014 Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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