Combination Therapy of Angiotensin II Receptor Blocker and Thiazide Produces Severe Hyponatremia in Elderly Hypertensive Subjects

Yamada, Hodaka; Asano, Tomoko; Aoki, Atsushi; Ikoma, Aki; Yoshida, Masashi; Kusaka, Ikuyo; Kawakami, Masanobu; Kakei, Masafumi; Ishikawa, San E.

doi:10.2169/internalmedicine.53.1738

Cited by 11 publications

(9 citation statements)

References 18 publications

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“…A low BMI could be a risk factor. 27 The associated use of angiotensin converting enzyme inhibitors (ACEi), 42 or angiotensin II receptor blockers (ARBs) 43 can increase the risk and/or severity of hyponatraemia, as can hypokalaemia. 42 We have observed that close to 60% of elderly patients with marked thiazide-related hyponatraemia are hypovolaemic, as classified by an initial physical examination that includes OP and CVP, with the remaining 40% euvolaemic.…”

Section: Physical Examinationmentioning

confidence: 99%

Hyponatraemia in older patients: a clinical and practical approach

Rünkle

Gómez-Hoyos

Cuesta-Hernandez

et al. 2015

Rev. Clin. Gerontol.

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Hyponatraemia is frequent in older people and induces marked motor and cognitive dysfunction, even in patients deemed 'asymptomatic'. Nutritional status is worse than in euvolaemic-matched controls, and the risk of fracture is increased following incidental falls. Yet hyponatraemia is undertreated, in spite of the fact that its correction is accompanied by a clear improvement in symptoms. Both evaluation of neurological symptoms and classification by volaemia are essential for a correct diagnosis and treatment of the hyponatraemic elderly patient. The syndrome of inappropriate anti-diuretic hormone secretion (SIADH) is the most common cause of hyponatraemia in older people. Nutritional status and chronicity of SIADH should be taken into account when deciding therapy. We propose an 8-step approach to the management of the elderly patient with hyponatraemia.

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Section: Physical Examinationmentioning

confidence: 99%

Hyponatraemia in older patients: a clinical and practical approach

Rünkle

Gómez-Hoyos

Cuesta-Hernandez

et al. 2015

Rev. Clin. Gerontol.

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“…Hyponatremia, which results from a multitude of causes besides medications, can manifest as delirium, falls, lethargy, stupor, and even seizures, based on the severity and acuity of development. Predisposing factors include increasing age, female sex, larger dose of thiazide or thiazide-like diuretics, presence of hypokalemia, and lower body mass index; different studies suggest the influence of ACEIs to be a predisposition and otherwise [28,[42][43][44][45][46][47][48][49]. In a given individual, besides diuretics, there may well exist other causes for hyponatremia, such as water retention caused by excessive water intake, psychogenic polydipsia, heavy beer intake, and impaired water-excreting ability [50].…”

Section: Diureticsmentioning

confidence: 99%

“…A study has suggested that risks included home institutionalization and physical immobility; duration of thiazide use; concomitant use of loop diuretics; body weight (increased mass decreased the odds); while the use of ACEIs and NSAIDs and renal function bore no association [46]. While hyponatremia clearly occurs with thiazide use and increases with age, views on other predispositions vary or contradict based on a given study [47][48][49]. Indapamide use is associated with hyponatremia [52].…”

Section: Diureticsmentioning

confidence: 99%

Tolerability of Antihypertensive Medications in Older Adults

Dharmarajan

2015

Drugs Aging

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Several guidelines for hypertension have recently undergone revisions to incorporate an approach providing choices of medications based on age, race, and specific situations where hypertension may co-exist with disorders such as diabetes, coronary artery disease, heart failure and chronic kidney disease. Initial recommendations include diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and calcium channel blockers; beta blockers are favored in some guidelines and are a choice in specific settings. Within the classes of drugs, several antihypertensive agents provide options. This review discusses antihypertensive drugs by class, including adverse effects and tolerability, with preferences in older adults and specific settings. Adverse drug events from antihypertensive medications are discussed by class and where applicable for specific agents. Data from select studies pertinent to tolerability and adverse effects are presented in tables for several classes of drugs. The rationale for nonadherence to medication is reviewed, including the roles played by tolerability and adverse drug effects. Antihypertensive therapy in typical settings in older adults is discussed; they include hypertension in association with impaired cognition, depression, diabetes, sexual dysfunction, and falls. The key to successful therapy and tolerability is to promote a healthy lifestyle in conjunction with medications as the approach, thereby also lowering the adverse drug effects. The eventual choice of the specific drug(s) is based on risks, benefits, and patient preferences, and is best tailored for each older adult.

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“…Drugs commonly used in elderly patients that may cause or worsen hypoNa (129) (130) (131) (132)(133) …”

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confidence: 99%