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Metabolic Side Effects Linked to Thiazide Diuretics

June 27, 2014 — Elderly people with high blood pressure are more likely to develop serious metabolic side effects if they take thiazide diuretics, according to a new study published in the Journal of the American Geriatrics Society.

Researchers from the University of Texas Southwestern Medical Center in Dallas based these conclusions on data from a study of over 2,000 veterans aged 65 or older (median age 74) who had high blood pressure. Half of the patients were given a thiazide diuretic and they were tracked for 9 months.

Thiazides are commonly prescribed to treat high blood pressure. They help the body excrete fluid in urine, which decreases the total volume of blood and makes it easier for the heart to circulate blood into the body.

The researchers found that metabolic side effects were more common in patients on thiazides, including:

  • Low potassium in the bloodstream (hypokalemia)
  • Low sodium (hyponatremia)
  • Kidney impairment of at least 25%.

After nine months, 14.3% of new thiazide users developed an adverse event, compared with 6.0% of nonusers; 1.8% of new users developed a severe adverse event, compared with 0.6% of nonusers; and 3.8% of new users had an emergency department visit or hospitalization with an adverse event, compared with 2.0% of nonusers.

The researchers advised doctors to consider prescribing other medications to older adults with multiple risk-factors for metabolic adverse events:

“Thiazide diuretics undoubtedly reduce cardiovascular morbidity and mortality in older adults with hypertension, but other classes of antihypertensive medications are equally effective in this population and are available at comparable costs in generic formulations.”

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