Division of General Internal Medicine and Primary Care, Brigham & Women's Hospital, Boston, MA, USA.
Am J Med. 2011 Nov;124(11):1064-72. doi: 10.1016/j.amjmed.2011.06.031.
Although hyponatremia is a well-recognized complication of treatment with thiazide diuretics, the risk of thiazide-induced hyponatremia remains uncertain in routine care.
We conducted a retrospective cohort study using a multicenter clinical research registry to identify 2613 adult outpatients that were newly treated for hypertension between January 1, 2000 and December 31, 2005 at 2 teaching hospitals in Boston, Massachusetts, and followed them for up to 10 years.
Two hundred twenty patients exposed to ongoing thiazide therapy were compared with 2393 patients who were not exposed. In the exposed group, 66 (30%) developed hyponatremia (sodium ≤130 mmol/L). The adjusted incidence rate of hyponatremia was 140 cases per 1000 person-years for patients treated with thiazides, compared with 87 cases per 1000 person-years in those without thiazides. Patients exposed to thiazides were more likely to develop hyponatremia (adjusted incidence rate ratio, 1.61; 95% confidence interval [CI], 1.15-2.25). There was no significant difference in the risk of hospitalizations associated with hyponatremia (adjusted rate ratio, 1.04; 95% CI, 0.46-2.32) or mortality (adjusted rate ratio, 0.41; 95% CI, 0.12-1.42). The number needed to harm (to result in one excess case of incident hyponatremia in 5 years) was 15.02 (95% CI, 7.88-160.30).
Approximately 3 in 10 patients exposed to thiazides who continue to take them develop hyponatremia.
尽管噻嗪类利尿剂治疗引起的低钠血症是一种众所周知的并发症，但噻嗪类诱导的低钠血症在常规治疗中的风险仍不确定。
我们进行了一项回顾性队列研究，使用多中心临床研究注册中心，确定了 2000 年 1 月 1 日至 2005 年 12 月 31 日期间在马萨诸塞州波士顿的 2 所教学医院新接受高血压治疗的 2613 例成年门诊患者，并对他们进行了长达 10 年的随访。
将 220 例接受持续噻嗪类治疗的患者与 2393 例未暴露的患者进行比较。在暴露组中，有 66 例（30%）发生低钠血症（钠≤130mmol/L）。噻嗪类治疗患者低钠血症的调整发病率为 140 例/1000 人年，而未用噻嗪类治疗的患者为 87 例/1000 人年。接受噻嗪类治疗的患者发生低钠血症的风险更高（调整发病率比，1.61；95%置信区间[CI]，1.15-2.25）。低钠血症相关住院的风险无显著差异（调整率比，1.04；95%CI，0.46-2.32）或死亡率（调整率比，0.41；95%CI，0.12-1.42）。危害人数（导致 5 年内低钠血症的发生率增加 1 例）为 15.02（95%CI，7.88-160.30）。
大约 10 名接受噻嗪类药物治疗且继续服用的患者中，有 3 人会出现低钠血症。
