Thiazides and the risk of hypokalemia in the general population
- 1 October 2014
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal Of Hypertension
- Vol. 32 (10), 2092-2097
- https://doi.org/10.1097/hjh.0000000000000299
Abstract
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. 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. 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. 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.Keywords
This publication has 20 references indexed in Scilit:
- The Rotterdam Study: 2012 objectives and design updateEuropean Journal of Epidemiology, 2011
- Sex‐related differences in hospital admissions attributed to adverse drug reactions in the NetherlandsBritish Journal of Clinical Pharmacology, 2010
- Analysis of individual drug use as a time-varying determinant of exposure in prospective population-based cohort studiesEuropean Journal of Epidemiology, 2010
- Changes in Serum Potassium Mediate Thiazide-Induced DiabetesHypertension, 2008
- Blood pressure drug therapy and electrolyte disturbancesInternational Journal of Clinical Practice, 2008
- Thiazide Diuretics, Potassium, and the Development of DiabetesHypertension, 2006
- Maxi-K channels contribute to urinary potassium excretion in the ROMK-deficient mouse model of Type II Bartter's syndrome and in adaptation to a high-K dietKidney International, 2006
- Thiazide diuretic prescription and electrolyte abnormalities in primary careBritish Journal of Clinical Pharmacology, 2005
- Major Outcomes in High-Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)Jama-Journal Of The American Medical Association, 2002
- Potassium Supplementation in Hypertensive Patients with Diuretic-Induced HypokalemiaThe New England Journal of Medicine, 1985