Antihypertensives and Severe Hyponatremia

Henrik Falhammar, Jakob Skov, Jan Calissendorff, David Nathanson, Jonatan D Lindh, Buster Mannheimer
The Journal of Clinical Endocrinology & Metabolism, Volume 105, Issue 10, 1 October 2020, dgaa194
https://doi.org/10.1210/clinem/dgaa194

Abstract

Background

Calcium channel blockers (CCBs), beta-receptor blockers (BBs), angiotensin-converting enzyme inhibitors (ACEIs), and angiotensin II receptor blockers (ARBs) have occasionally been reported to cause severe hyponatremia. The aim was to explore the association between CCBs, BBs, ACEIs, and ARBs and hospitalization due to hyponatremia.

Methods

Patients hospitalized with a principal diagnosis of hyponatremia (n = 11 213) were compared with matched controls (n = 44 801). Linkage of national population-based registers was used to acquire data. Multivariable logistic regression adjusting for co-medications, diseases, previous hospitalizations, and socioeconomic factors was used to explore the association between hospitalization for severe hyponatremia and the use of different CCBs, BBs, ACEIs, and ARBs. Furthermore, newly initiated (≤90 days) and ongoing use were examined separately.

Results

Adjusted odds ratios (aORs) (95% confidence interval) for the investigated 4 drug classes ranged from 0.86 (0.81–0.92) for CCBs to 1.15 (1.07–1.23) for ARBs. For newly initiated drugs, aORs spanned from 1.64 (1.35–1.98) for CCBs to 2.24 (1.87–2.68) for ACEIs. In contrast, the corresponding associations for ongoing therapy were not elevated, ranging from 0.81 (0.75–0.86) for CCBs to 1.08 (1.00–1.16) for ARBs. In the CCBs subgroups, aOR for newly initiated vascular CCBs was 1.95 (1.62–2.34) whereas aOR for ongoing treatment was 0.82 (0.77–0.88).

Conclusions

For newly initiated CCBs, BBs, ACEIs, and ARBs, the risk of hospitalization due to hyponatremia was moderately elevated. In contrast, there was no evidence that ongoing treatment with investigated antihypertensive drugs increased the risk for hospitalization due to hyponatremia.

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