- •Age: there were significantly more elderly patients in the thiazide group. Several conditions common in the elderly (Parkinson disease, diabetes, autonomic neuropathy, cerebrovascular diseases, cardiovascular disease) could cause syncope.2
- •Chronic kidney disease and acute kidney injury: results in electrolyte derangements,3including increased medications like loop diuretics.
- •Nonsteroidal anti-inflammatory drugs: Inhibition of renal prostaglandin synthesis can cause electrolyte and acid-base disturbances (sodium retention, hyponatremia, hyperkalemia, and decreased renal function).5
- •Renin-angiotensin-aldosterone system (RAAS) inhibitors: may lead to higher incidence of hypotension, acute renal failure, or hyperkalemia. RAAS inhibitors may cause hyponatremia due to their anti-aldosterone action.6
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- Syncope in older adults.J Geriatr Cardiol. 2016; 13: 380-386
- Electrolyte and acid-base disorders in chronic kidney disease and end-stage kidney failure.Blood Purif. 2017; 43: 179-188
Huxel C, Raja A, Ollivierre-Lawrence MD. Loop diuretics. Available at: https://www.ncbi.nlm.nih.gov/books/NBK546656/. Accessed on 13 Dec 2021.
- Electrolyte and acid-base disturbances associated with non-steroidal anti-inflammatory drugs.Electrolyte Blood Press. 2007; 5: 116-125
- Hyponatremia induced by angiotensin converting enzyme inhibitors and angiotensin receptor blockers-a pilot study.J Clin Diagn Res. 2018; 12: FC01-FC03
- Hyponatremia in patients on thiazides - SIADH vs. true TIH. Comment on: Ware JS, Wain LV, Channavajjhala SK, et al. Phenotypic and pharmacogenetic evaluation of patients with thiazide-induced hyponatremia.J Clin Invest. 2017; 127 (https://www.jci.org/eletters/view/89812#sec1. Accessed on 13 Dec 2021): 3367-3374
- Optimising TRIUMPH with 6·25 mg chlorthalidone.Lancet Glob Health. 2020; 8: e175
Funding: No funding was received for this work.
Conflicts of Interest: All authors are employees of Ipca Laboratories Limited, which is involved in research of chlorthalidone and other antihypertensives.
Authorship: All authors were involved in writing the manuscript.