Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China.
Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.
J Hum Hypertens. 2023 May;37(5):354-362. doi: 10.1038/s41371-022-00704-x. Epub 2022 May 6.
Hydrochlorothiazide is the most common thiazide diuretic used for hypertension in the US. Yet, hypokalaemia is a well-recognised adverse effect. To evaluate the prevalence and factors associated with hypokalaemia (serum potassium < 3.5 mmol/L) among hydrochlorothiazide users, we included US adults aged ≥20 years in the 1999-2018 National Health and Nutrition Examination Survey. Participants were categorised according to the use of hydrochlorothiazide and other antihypertensive agents. Factors associated with hypokalaemia, including demographics and prescription patterns (monotherapy vs single-pill fixed-dose combination vs polytherapy) were studied using multivariable logistic regression. Hypokalaemia was present in 12.6% of the hydrochlorothiazide users, equivalent to ~2.0 million US adults. Women (adjusted OR, 2.22; 95% CI, 1.74-2.83), non-Hispanic blacks (adjusted OR, 1.65; 95% CI, 1.31-2.08), underweight (adjusted OR, 4.33; 95% CI, 1.34-13.95), and participants taking hydrochlorothiazide for five years or more (adjusted OR, 1.47; 95% CI, 1.06-2.04) had a higher risk of hypokalaemia. Compared to monotherapy, fixed-dose combination therapy (adjusted OR, 0.32; 95% CI, 0.21-0.48) was associated with the lowest risk. Among those taking potassium supplements, hypokalaemia was found in 27.2% of participants on monotherapy and 17.9% on polytherapy. The prevalence of hypokalaemia among hydrochlorothiazide users was considerable, even among participants who also took potassium supplements. Women, ethnic minorities, underweight, monotherapy, and participants with long-term therapy are more likely to have hypokalaemia. Regular monitoring of potassium and combination with potassium-sparing drugs are needed.
氢氯噻嗪是美国最常用的噻嗪类利尿剂，用于治疗高血压。然而，低钾血症是一种公认的不良反应。为了评估氢氯噻嗪使用者低钾血症（血清钾 < 3.5mmol/L）的患病率和相关因素，我们纳入了 1999 年至 2018 年国家健康和营养调查中的美国≥20 岁成年人。参与者根据氢氯噻嗪和其他降压药物的使用情况进行分类。使用多变量逻辑回归研究低钾血症的相关因素，包括人口统计学和处方模式（单药治疗与单一药丸固定剂量联合治疗与多药治疗）。在氢氯噻嗪使用者中，有 12.6%存在低钾血症，相当于约 200 万美国成年人。女性（调整后的 OR，2.22；95%CI，1.74-2.83）、非西班牙裔黑人（调整后的 OR，1.65；95%CI，1.31-2.08）、体重不足（调整后的 OR，4.33；95%CI，1.34-13.95）和使用氢氯噻嗪治疗五年或以上的参与者（调整后的 OR，1.47；95%CI，1.06-2.04）发生低钾血症的风险更高。与单药治疗相比，固定剂量联合治疗（调整后的 OR，0.32；95%CI，0.21-0.48）与最低风险相关。在服用钾补充剂的患者中，单药治疗组有 27.2%的患者出现低钾血症，多药治疗组有 17.9%的患者出现低钾血症。即使在同时服用钾补充剂的患者中，氢氯噻嗪使用者的低钾血症患病率也相当高。女性、少数民族、体重不足、单药治疗和长期治疗的参与者更有可能出现低钾血症。需要定期监测血钾并与保钾药物联合使用。
