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Incidence of severe hypokalaemia in patients taking indapamide

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Abstract

Background

Diuretics are commonly used for the treatment of hypertension. Yet, hypokalaemia is a well-recognised adverse effect. We conducted a retrospective study to evaluate the incidence of severe hypokalaemia, defined as requiring hospitalisation, among patients on indapamide.

Methods

We searched a territory-wide database, Clinical Data Analysis and Reporting System of the Hong Kong Hospital Authority. We traced all hypertensive patients who had been prescribed indapamide in 2007–2016 and all admissions due to hypokalaemia in 2007–2018. Factors associated with hospitalisation were studied using multivariable logistic regression.

Results

During the period studied, 62,881 patients were started on indapamide and 509 (0.8%) were hospitalised for hypokalaemia. 53% of these hospitalisations occurred within the first year of treatment, and half of those in the first year occurred during the first 16 weeks. Female sex (adjusted OR, 1.75; 95%CI, 1.45–2.12) and immediate-release formulation (adjusted OR, 1.41; 95%CI, 1.14–1.75) were associated with hospitalisation. In the multivariable model, advanced age was not a significant predictor. There were no deaths during hospitalisation and the median length of hospital stay was one day.

Conclusions

In this large population-based study with 147,319 person-years of follow-up, severe hypokalaemia requiring hospitalisation was uncommon among hypertensive patients on indapamide. The risk is higher in women and in the initial weeks and months after starting therapy. The use of the sustained-release formulation reduces the risk. We conclude that using indapamide to treat hypertension is safe, even in the elderly, especially if the sustained-release formulation is used and electrolytes are monitored periodically.

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Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

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Authors and Affiliations

  1. Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China

    Ziying Lin, Bernard Man Yung Cheung & Vicka Tang

  2. State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Pokfulam, Hong Kong, China

    Bernard Man Yung Cheung

  3. Institute of Cardiovascular Science and Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China

    Bernard Man Yung Cheung

  4. Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK

    Man Fung Tsoi

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  1. Ziying Lin
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  4. Man Fung Tsoi
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Contributions

ZL: Conceptualization, Formal analysis, Writing—Original Draft. BMYC: Conceptualization, Resources, Writing—Review and Editing, Supervision. VT: Methodology, Visualisation, Validation. MFT: Methodology, Software, Validation, Writing—Review and Editing. All authors critically revised the manuscript and had responsibility for the final content.

Corresponding author

Correspondence to Bernard Man Yung Cheung.

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The authors declare that they have no conflict of interest.

Ethics approval and consent to participate

The study protocol was approved by the Institutional Review Board of the University of Hong Kong and the West Cluster of the Hong Kong Hospital Authority.

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Lin, Z., Cheung, B.M.Y., Tang, V. et al. Incidence of severe hypokalaemia in patients taking indapamide. Intern Emerg Med 18, 549–557 (2023). https://doi.org/10.1007/s11739-023-03209-8

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