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Risk of Thiazide‐Induced Metabolic Adverse Events in Older Adults
Author(s) -
Makam Anil N.,
John Boscardin W.,
Miao Yinghui,
Steinman Michael A.
Publication year - 2014
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.12839
Subject(s) - medicine , thiazide , odds ratio , number needed to harm , confidence interval , adverse effect , comorbidity , relative risk , number needed to treat , diuretic
Objectives To evaluate the risk and predictors of thiazide‐induced adverse events ( AE s) in multimorbid older adults in real‐world clinical settings. Design Observational cohort study. Setting National Veterans Affairs data from 2007 to 2008. Participants Veterans aged 65 and older newly prescribed a thiazide (N = 1,060) compared with propensity‐matched nonusers of antihypertensive medications (N = 1,060). Measurements The primary outcome was a composite of metabolic AEs defined as sodium less than 135 mEq/L, potassium less than 3.5 mEq/L, or a decrease in the estimated glomerular filtration rate (e GFR ) of more than 25% from the baseline rate. Secondary outcomes included sev‐ere AEs (sodium <130 mEq/L, potassium <3.0 mEq/L, or a decrease in e GFR of more than 50%). Results Over 9 months of follow‐up, 14.3% of new thiazide users developed an AE , compared with 6.0% of nonusers (number needed to harm ( NNH ) 12, 95% confidence interval ( CI ) = 9–17, P < .001); 1.8% of new users developed a severe AE , compared with 0.6% of nonusers ( NNH = 82, P = .008), and 3.8% of new users had an emergency department visit or hospitalization with an AE , compared with 2.0% of nonusers ( NNH = 56, P = .02). Risk of AE s did not vary according to age, but having five or more comorbidities was associated with 3.0 times the odds (95% CI = 1.4–6.2) of developing an AE as having one comorbidity (hypertension). Low‐normal and unmeasured baseline sodium and potassium values were among the strongest predictors of hyponatremia and hypokalemia, respectively. Only 42% of thiazide users had laboratory monitoring within 90 days after initiation. Conclusion Thiazide‐induced AE s are common in older adults. Greater attention should be paid to potential complications in prescribing thiazides to older adults, including closer laboratory monitoring before and after initiation of thiazides.