Thiazides and the risk of hypokalemia in the general population
OBJECTIVES:Hypokalemia is a frequent adverse reaction to thiazide diuretics, but is often asymptomatic. However, even asymptomatic hypokalemia may contribute to chronic disabilities and mortality. The aim of this study was to assess the risk of thiazide-induced hypokalemia in men and women in the ge...
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| Veröffentlicht in: | Journal of hypertension 2014-10, Vol.32 (10), p.2092-2097 |
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| container_title | Journal of hypertension |
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| creator | Rodenburg, Eline M Visser, Loes E Hoorn, Ewout J Ruiter, Rikje Lous, Jan J Hofman, Albert Uitterlinden, André G Stricker, Bruno H |
| description | OBJECTIVES:Hypokalemia is a frequent adverse reaction to thiazide diuretics, but is often asymptomatic. However, even asymptomatic hypokalemia may contribute to chronic disabilities and mortality. The aim of this study was to assess the risk of thiazide-induced hypokalemia in men and women in the general population.
METHODS:Within the Rotterdam study, which is a population-based cohort study, the association between thiazide exposure and hypokalemia (serum potassium level |
| doi_str_mv | 10.1097/HJH.0000000000000299 |
| format | Article |
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METHODS:Within the Rotterdam study, which is a population-based cohort study, the association between thiazide exposure and hypokalemia (serum potassium level <3.5 mmol/l; moderate to severe ≤3.0 mmol/l) was studied using Cox proportional-hazard regression analysis over a 10-year period, with thiazide use as a time-varying exposure.
RESULTS:During follow-up, 507 cases of hypokalemia occurred in 13 328 patients. Thiazide use was associated with an 11 times higher risk of hypokalemia than no use [relative risk (RR) 11.18, 95% confidence interval (CI) 8.95, 13.96] after adjustment for sex, age, and use of a renin–angiotensin system (RAS) inhibitor or separate potassium-sparing diuretic. In users of a thiazide in combination with triamterene, the risk was still six times higher (RR 5.93, 95% CI 4.65, 7.55) than in nonusers. The risk of thiazide-induced hypokalemia was significantly higher in men than in women and changed significantly with age and dosage. The risk of moderate to severe hypokalemia was almost five times higher in thiazide users (RR 4.80, 95% CI 2.61, 8.84) than in nonusers.
CONCLUSION:The risk of thiazide-induced hypokalemia is high, and more than twice as high in men as in women. Hypokalemia risk is influenced by age and dosage, and is still increased if used in combination with triamterene.</description><identifier>ISSN: 0263-6352</identifier><identifier>EISSN: 1473-5598</identifier><identifier>DOI: 10.1097/HJH.0000000000000299</identifier><identifier>PMID: 25105457</identifier><language>eng</language><publisher>England: Wolters Kluwer Health | Lippincott Williams & Wilkins</publisher><subject>Aged ; Angiotensin Receptor Antagonists ; Cohort Studies ; Female ; Humans ; Hypokalemia - chemically induced ; Hypokalemia - epidemiology ; Male ; Middle Aged ; Netherlands - epidemiology ; Potassium - blood ; Renin-Angiotensin System - drug effects ; Risk ; Sodium Chloride Symporter Inhibitors - adverse effects ; Thiazides - adverse effects</subject><ispartof>Journal of hypertension, 2014-10, Vol.32 (10), p.2092-2097</ispartof><rights>2014 Wolters Kluwer Health | Lippincott Williams & Wilkins</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4779-52783969586e897f34586587fb1cadb9f62bb7cc0d00216bc13f6e7db29f238a3</citedby><cites>FETCH-LOGICAL-c4779-52783969586e897f34586587fb1cadb9f62bb7cc0d00216bc13f6e7db29f238a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25105457$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rodenburg, Eline M</creatorcontrib><creatorcontrib>Visser, Loes E</creatorcontrib><creatorcontrib>Hoorn, Ewout J</creatorcontrib><creatorcontrib>Ruiter, Rikje</creatorcontrib><creatorcontrib>Lous, Jan J</creatorcontrib><creatorcontrib>Hofman, Albert</creatorcontrib><creatorcontrib>Uitterlinden, André G</creatorcontrib><creatorcontrib>Stricker, Bruno H</creatorcontrib><title>Thiazides and the risk of hypokalemia in the general population</title><title>Journal of hypertension</title><addtitle>J Hypertens</addtitle><description>OBJECTIVES:Hypokalemia is a frequent adverse reaction to thiazide diuretics, but is often asymptomatic. However, even asymptomatic hypokalemia may contribute to chronic disabilities and mortality. The aim of this study was to assess the risk of thiazide-induced hypokalemia in men and women in the general population.
METHODS:Within the Rotterdam study, which is a population-based cohort study, the association between thiazide exposure and hypokalemia (serum potassium level <3.5 mmol/l; moderate to severe ≤3.0 mmol/l) was studied using Cox proportional-hazard regression analysis over a 10-year period, with thiazide use as a time-varying exposure.
RESULTS:During follow-up, 507 cases of hypokalemia occurred in 13 328 patients. Thiazide use was associated with an 11 times higher risk of hypokalemia than no use [relative risk (RR) 11.18, 95% confidence interval (CI) 8.95, 13.96] after adjustment for sex, age, and use of a renin–angiotensin system (RAS) inhibitor or separate potassium-sparing diuretic. In users of a thiazide in combination with triamterene, the risk was still six times higher (RR 5.93, 95% CI 4.65, 7.55) than in nonusers. The risk of thiazide-induced hypokalemia was significantly higher in men than in women and changed significantly with age and dosage. The risk of moderate to severe hypokalemia was almost five times higher in thiazide users (RR 4.80, 95% CI 2.61, 8.84) than in nonusers.
CONCLUSION:The risk of thiazide-induced hypokalemia is high, and more than twice as high in men as in women. Hypokalemia risk is influenced by age and dosage, and is still increased if used in combination with triamterene.</description><subject>Aged</subject><subject>Angiotensin Receptor Antagonists</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Humans</subject><subject>Hypokalemia - chemically induced</subject><subject>Hypokalemia - epidemiology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Netherlands - epidemiology</subject><subject>Potassium - blood</subject><subject>Renin-Angiotensin System - drug effects</subject><subject>Risk</subject><subject>Sodium Chloride Symporter Inhibitors - adverse effects</subject><subject>Thiazides - adverse effects</subject><issn>0263-6352</issn><issn>1473-5598</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMtOwzAQRS0EoqXwBwhlySbFj9iOVwhVQEGV2JS15SQ2MXWTYCeqytdjaEGIBbOZkebceVwAzhGcIij41fxxPoW_AwtxAMYo4ySlVOSHYAwxIykjFI_ASQivkckFJ8dghCmCNKN8DK6XtVXvttIhUU2V9LVOvA2rpDVJve3alXJ6bVVim6_Wi260Vy7p2m5wqrdtcwqOjHJBn-3zBDzf3S5n83TxdP8wu1mkZca5SCnmORFM0JzpeIMhWaxozk2BSlUVwjBcFLwsYRX_QKwoETFM86rAwmCSKzIBl7u5nW_fBh16ubah1M6pRrdDkIgySLlgSEQ026Glb0Pw2sjO27XyW4mg_LRORuvkX-ui7GK_YSjWuvoRfXsVgXwHbFrXax9WbthoL2utXF__P_sDYXJ5Pg</recordid><startdate>201410</startdate><enddate>201410</enddate><creator>Rodenburg, Eline M</creator><creator>Visser, Loes E</creator><creator>Hoorn, Ewout J</creator><creator>Ruiter, Rikje</creator><creator>Lous, Jan J</creator><creator>Hofman, Albert</creator><creator>Uitterlinden, André G</creator><creator>Stricker, Bruno H</creator><general>Wolters Kluwer Health | Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201410</creationdate><title>Thiazides and the risk of hypokalemia in the general population</title><author>Rodenburg, Eline M ; Visser, Loes E ; Hoorn, Ewout J ; Ruiter, Rikje ; Lous, Jan J ; Hofman, Albert ; Uitterlinden, André G ; Stricker, Bruno H</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4779-52783969586e897f34586587fb1cadb9f62bb7cc0d00216bc13f6e7db29f238a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Angiotensin Receptor Antagonists</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Humans</topic><topic>Hypokalemia - chemically induced</topic><topic>Hypokalemia - epidemiology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Netherlands - epidemiology</topic><topic>Potassium - blood</topic><topic>Renin-Angiotensin System - drug effects</topic><topic>Risk</topic><topic>Sodium Chloride Symporter Inhibitors - adverse effects</topic><topic>Thiazides - adverse effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rodenburg, Eline M</creatorcontrib><creatorcontrib>Visser, Loes E</creatorcontrib><creatorcontrib>Hoorn, Ewout J</creatorcontrib><creatorcontrib>Ruiter, Rikje</creatorcontrib><creatorcontrib>Lous, Jan J</creatorcontrib><creatorcontrib>Hofman, Albert</creatorcontrib><creatorcontrib>Uitterlinden, André G</creatorcontrib><creatorcontrib>Stricker, Bruno H</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of hypertension</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rodenburg, Eline M</au><au>Visser, Loes E</au><au>Hoorn, Ewout J</au><au>Ruiter, Rikje</au><au>Lous, Jan J</au><au>Hofman, Albert</au><au>Uitterlinden, André G</au><au>Stricker, Bruno H</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Thiazides and the risk of hypokalemia in the general population</atitle><jtitle>Journal of hypertension</jtitle><addtitle>J Hypertens</addtitle><date>2014-10</date><risdate>2014</risdate><volume>32</volume><issue>10</issue><spage>2092</spage><epage>2097</epage><pages>2092-2097</pages><issn>0263-6352</issn><eissn>1473-5598</eissn><abstract>OBJECTIVES:Hypokalemia is a frequent adverse reaction to thiazide diuretics, but is often asymptomatic. However, even asymptomatic hypokalemia may contribute to chronic disabilities and mortality. The aim of this study was to assess the risk of thiazide-induced hypokalemia in men and women in the general population.
METHODS:Within the Rotterdam study, which is a population-based cohort study, the association between thiazide exposure and hypokalemia (serum potassium level <3.5 mmol/l; moderate to severe ≤3.0 mmol/l) was studied using Cox proportional-hazard regression analysis over a 10-year period, with thiazide use as a time-varying exposure.
RESULTS:During follow-up, 507 cases of hypokalemia occurred in 13 328 patients. Thiazide use was associated with an 11 times higher risk of hypokalemia than no use [relative risk (RR) 11.18, 95% confidence interval (CI) 8.95, 13.96] after adjustment for sex, age, and use of a renin–angiotensin system (RAS) inhibitor or separate potassium-sparing diuretic. In users of a thiazide in combination with triamterene, the risk was still six times higher (RR 5.93, 95% CI 4.65, 7.55) than in nonusers. The risk of thiazide-induced hypokalemia was significantly higher in men than in women and changed significantly with age and dosage. The risk of moderate to severe hypokalemia was almost five times higher in thiazide users (RR 4.80, 95% CI 2.61, 8.84) than in nonusers.
CONCLUSION:The risk of thiazide-induced hypokalemia is high, and more than twice as high in men as in women. Hypokalemia risk is influenced by age and dosage, and is still increased if used in combination with triamterene.</abstract><cop>England</cop><pub>Wolters Kluwer Health | Lippincott Williams & Wilkins</pub><pmid>25105457</pmid><doi>10.1097/HJH.0000000000000299</doi><tpages>6</tpages></addata></record> |
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| subjects | Aged Angiotensin Receptor Antagonists Cohort Studies Female Humans Hypokalemia - chemically induced Hypokalemia - epidemiology Male Middle Aged Netherlands - epidemiology Potassium - blood Renin-Angiotensin System - drug effects Risk Sodium Chloride Symporter Inhibitors - adverse effects Thiazides - adverse effects |
| title | Thiazides and the risk of hypokalemia in the general population |
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