Abstract
Diuretics are recommended as first-line antihypertensive treatment in elderly patients. Although attention is usually paid to prevent hypokalaemia with diuretic therapy, risk of hyponatraemia is often ignored. We performed this study to characterise hypertensive patients at increased risk to develop hyponatraemia. We reviewed charts of hypertensive patients hospitalised in Chaim Sheba Medical Center for hyponatraemia from 1990 to 1997. Patients with other causes of hyponatraemia were excluded. The General Practice Maccabi database was used to estimate age and sex distribution of patients prescribed diuretics for hypertension. We identified 180 hypertensive patients (149 F, 31 M; mean age 76.4 ± 9.2 years) hospitalised because of hyponatraemia. Across all age groups, odds ratio (OR) to develop hyponatraemia was three times higher for women vs men (OR 3.10, 95% confidence interval (CI): 2.07–4.67). One hundred and sixty-two patients (90%) were older than 65 years. Patients of both sexes older than 65 years were 10 times (and if they were older than 75 years 16 times) more likely to develop hyponatraemia than those younger than 65 years (OR 9.87, 95%, CI: 5.93–16.64). Most patients (74.5%) used a thiazide-based diuretic; only 10% used a low dose (<25 mg/day). In 37% of patients diuretics were used for more than 1 year before hyponatraemia developed. Diuretic-induced hyponatraemia may be insidious and appear even after prolonged diuretics use. Elderly women seem to be at particularly high risk. In this population diuretic use should be associated with close monitoring of sodium and potassium levels.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 digital issues and online access to articles
$119.00 per year
only $9.92 per issue
Rent or buy this article
Prices vary by article type
from$1.95
to$39.95
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure Arch Intern Med 1997 157: 2413–2446
SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP) JAMA 1991 265: 3255–3264
Messerli FH, Grossman E, Goldbourt U . Are beta-blockers efficacious as first-line therapy for hypertension in the elderly? A systematic review JAMA 1998 279: 1903–1907
Kostis JB et al. The effect of chlorthalidone on ventricular ectopic activity inpatients with isolated systolic hypertension. The SHEP Study Group Am J Cardiol 1994 74: 464–467
Siegel D et al. Diuretics, serum and intracellular electrolyte levels, and ventricular arrhythmias in hypertensive men JAMA 1992 267: 1083–1089
Siscovick DS et al. Diuretic therapy for hypertension and the risk of primary cardiac arrest N Engl J Med 1994 330: 1852–1857
Weir MR, Flack JM, Applegate WB . Tolerability, safety, and quality of life and hypertensive therapy: the case for low-dose diuretics Am J Med 1996 101: 83S–92S
Sonneblick M, Friedlander Y, Rosin AJ . Diuretic-induced severe hyponatremia. Review and analysis of 129 reportedpatients Chest 1993 103: 601–606
Sunderam SG, Mankikar GD . Hyponatraemia in the elderly Age Ageing 1983 12: 77–80
Siegler EL et al. Risk factors for the development of hyponatremia in psychiatric inpatients Arch Intern Med 1995 155: 953–957
Mozes B et al. Thiazide-induced hyponatremia: an unusual neurologic course South Med J 1986 79: 629–631
Sonnenblick M, Algur N, Rosin A . Thiazide-induced hyponatremia and vasopressin release (letter) Ann Intern Med 1989 110: 751
Friedman E, Shadel M, Halkin H, Farfel Z . Thiazide-induced hyponatremia. Reproducibility by single dose rechallenge and an analysis of pathogenesis Ann Intern Med 1989 110: 24–30
Gahlinger PM, Abramson JH . CASECONT in Programs for Epidemiologic Analysis (PEPI). Vol. 2 Stone Mountain: GA, USA 1995
Roberts CJ, Mitchell JV, Donley AJ . Hyponatraemia: adverse effect of diuretic treatment Br Med J 1977 1: 210
Roberts CJ, Channer KS, Bungay D . Hyponatraemia induced by a combination of hydrochlorothiazide and triamterene Br Med J 1984 (Clin Res Ed) 288: 1962
Oles KS, Denham JW . Hyponatremia induced by thiazide-like diuretics in the elderly South Med J 1984 77: 1314–1315
Strykers PH, Stern RS, Morse BM . Hyponatremia induced by a combination of amiloride and hydrochlorothiazide JAMA 1984 252: 389
Johnson JE, Wright LF . Thiazide-induced hyponatremia South Med J 1983 76: 1363–1367
Hamburger S, Koprivica B, Ellerbeck E, Covinsky JO . Thiazide-induced syndrome of inappropriate secretion of antidiuretic hormone. Time course of resolution JAMA 1981 246: 1235–1236
Husby S, Marthedal NJ . Hyponatraemia due to a thiazide diuretic. A case report Acta Med Scand 1981 210: 523–524
Fichman MP, Vorherr H, Kleeman CR, Telfer N . Diuretic-induced hyponatremia Ann Intern Med 1971 75: 853–863
Klungel OH et al. Sex differences in the pharmacological treatment of hypertension: a review of population-based studies J Hypertens 1997 15: 591–600
Klungel OH et al. Sex differences in antihypertensive drug use: determinants of the choice of medication for hypertension J Hypertens 1998 16: 1545–1553
Ayus JC, Wheeler JM, Arieff AI . Postoperative hyponatremic encephalopathy in menstruant women Ann Intern Med 1992 117: 891–897
Kone B, Gimenez L, Watson AJ . Thiazide-induced hyponatremia South Med J 1986 79: 1456–1457
Goldenberg I, Jonas M, Thaler M, Grossman E . Elevated levels of serum creatine kinase induced by hyponatraemia Postgrad Med J 1997 73: 511–512
Author information
Authors and Affiliations
Corresponding author
Additional information
Presented at the International Society of Hypertension in Chicago, Illinois on 20–24 August 2000
Rights and permissions
About this article
Cite this article
Sharabi, Y., Illan, R., Kamari, Y. et al. Diuretic induced hyponatraemia in elderly hypertensive women. J Hum Hypertens 16, 631–635 (2002). https://doi.org/10.1038/sj.jhh.1001458
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.jhh.1001458
Keywords
This article is cited by
-
Thiazide-associated hyponatremia increases the risk of major adverse cardiovascular events among elderly Taiwanese patients
BMC Geriatrics (2023)
-
Long-Term Safety of Dapagliflozin in Older Patients with Type 2 Diabetes Mellitus: A Pooled Analysis of Phase IIb/III Studies
Drugs & Aging (2016)
-
Hyponatremia in the outpatient setting: clinical characteristics, risk factors, and outcome
International Urology and Nephrology (2015)
-
Tolerability of Antihypertensive Medications in Older Adults
Drugs & Aging (2015)