Uric Acid Elevations Differ Between Equivalent Hydrochlorothiazide and Indapamide Doses

Yıl 2024, Cilt: 46 Sayı: 1, 131 - 138, 16.01.2024

Alper Tuna Güven , Murat Özdede , Yusuf Ziya Şener , Ali Osman Yıldırım

https://doi.org/10.20515/otd.1346940

Öz

Thiazide diuretics are among the major anti-hypertensive medications. Hydrochlorothiazide and indapamide are among the most commonly used thiazides. Common side effects include impaired renal function and electrolyte disturbances. Whether hydrochlorothiazide and indapamide cause the same amount of disturbance at equivalent doses is uncertain. Patient data from four different clinics was analyzed. Patients whose thiazide diuretic was initiated or dose escalated were included if they met the inclusion criteria. Patient characteristics, including demographics, comorbidities, medications, renal function, and electrolyte values at the initial visit and control visit, and hydrochlorothiazide or indapamide exposure per milligram, were acquired. Indapamide doses were multiplied by ten to convert into equivalent thiazide doses. Changes in renal function and electrolyte values, and renal function and electrolyte changes per equivalent thiazide exposure, were calculated. The uric acid increase and potassium decrease were different for the indapamide and hydrochlorothiazide groups. However, when these changes were analyzed per equivalent thiazide exposure, potassium was not different, but the uric acid increase was still significantly different between indapamide and hydrochlorothiazide (.05(.08) vs .03 (.08) mg/dL per equivalent mg thiazide, p = .049). This study demonstrated that indapamide’s hyperuricemic effect is more profound than that of hydrochlorothiazide. Choosing hydrochlorothiazide instead of indapamide may be more appropriate in patients with higher initial uric acid levels.

Anahtar Kelimeler

Hypertension, uric acid, thiazides, hydrochlorothiazide, indapamide

Ürik Asit Artışları Eşdeğer Hidroklorotiyazid ve İndapamid Dozları Arasında Farklılık Gösterir

Öz

Tiyazid diüretikleri ana anti-hipertansif ilaç gruplarındandır. Hidroklorotiyazid ve indapamid en sık kullanılan tiyazidler arasındadır. Sık izlenen yan etkileri böbrek fonksiyon ve elektrolit bozukluklarıdır. Hidroklorotiyazid ve indapamidin aynı eşdeğer dozlarında aynı miktarda bozukluğa neden olup olmadığı net değildir. Dört farklı klinikten hasta bilgileri incelendi. Tiyazid diüretik başlanan veya dozu arttırılan hastalar, dahil olma koşullarını karşılamaları durumunda çalışmaya dahil edildiler. Demografik veri, hastalıklar, ilaçlar, başlangıç ve kontrol vizitlerindeki böbrek fonksiyon ve elektrolit değerleri ile maruz kalınan hidroklorotiyazid veya indapamid dozlarından oluşan hasta özellikleri elde edildi. İndapamid dozu eşdeğer tiyazid dozuna çevrim için on ile çarpıldı. Böbrek fonksiyon ve elektrolit değerlerindeki değişimler ile eşdeğer tiyazid maruziyeti başına oluşan böbrek fonksiyon ve elektrolit değişimleri hesaplandı. İndapamid ve hidroklorotiyazid grupları arasında ürik asit artışı ve potasyum düşüşü açısından fark vardı. Bu değişimler eşdeğer tiyazid maruziyeti başına incelendiğinde potasyum düşüşü arasında fark yoktu ancak ürik asit artışı indapamid ve hidroklorotiyazid grupları arasında hala anlamlı derecede farklıydı (eşdeğer tiyazid mg'si başına .05(.08)mg/dL vs .03 (.08) mg/dL, p = .049). Bu çalışma indapamidin hiperürisemik etkisinin hydroklorotiyazidin olduğundan daha derin olduğunu göstermiştir. Başlangıç ürik asit seviyeleri daha yüksek olan hastalarda indapamid yerine hidroklorotiyazid seçilmesi daha uygun olabilir.

Anahtar Kelimeler

hipertansiyon, ürik asit, tiyazid, hidroklorotiyazid, indapamid

Kaynakça

• 1. Brouwers S, Sudano I, Kokubo Y, Sulaica EM. Arterial hypertension. Lancet. 2021;398(10296):249-261.
• 2. Lønnebakken MT, Izzo R, Mancusi C, et al. Left Ventricular Hypertrophy Regression During Antihypertensive Treatment in an Outpatient Clinic (the Campania Salute Network). J Am Heart Assoc. 2017;6(3):e004152.
• 3. Mancia Chairperson G, Kreutz Co-Chair R, Brunström M, et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH) [published online ahead of print, 2023 Jun 21]. J Hypertens.
• 4. Roush GC, Ernst ME, Kostis JB, Tandon S, Sica DA. Head-to-head comparisons of hydrochlorothiazide with indapamide and chlorthalidone: antihypertensive and metabolic effects. Hypertension. 2015;65(5):1041-1046.
• 5. Jentzer JC, DeWald TA, Hernandez AF. Combination of loop diuretics with thiazide-type diuretics in heart failure. J Am Coll Cardiol. 2010;56(19):1527-1534.
• 6. Sica DA, Carter B, Cushman W, Hamm L. Thiazide and loop diuretics. J Clin Hypertens (Greenwich). 2011;13(9):639-643.
• 7. Ohta Y, Kamide K, Hanada H, et al. Genetic factors associated with elevation of uric acid after treatment with thiazide-like diuretic in patients with essential hypertension. Hypertens Res. 2020;43(3):220-226.
• 8. Burnier M, Bakris G, Williams B. Redefining diuretics use in hypertension: why select a thiazide-like diuretic?. J Hypertens. 2019;37(8):1574-1586.
• 9. Lin JJ, Chang HC, Ku CT, Chen HY. Hydrochlorothiazide hypertension treatment induced metabolic effects in type 2 diabetes: a meta-analysis of parallel-design RCTs. Eur Rev Med Pharmacol Sci. 2016;20(13):2926-2934.
• 10. Güven AT, Özdede M, Şener YZ, et al. Evaluation of machine learning algorithms for renin-angiotensin-aldosterone system inhibitors associated renal adverse event prediction. Eur J Intern Med. 2023;114:74-83.
• 11. Ernst ME, Fravel MA. Thiazide and the Thiazide-Like Diuretics: Review of Hydrochlorothiazide, Chlorthalidone, and Indapamide. Am J Hypertens. 2022;35(7):573-586.
• 12. Beermann B, Groschinsky-Grind M. Clinical pharmacokinetics of diuretics. Clin Pharmacokinet. 1980;5(3):221-245.
• 13. Weidmann P. Metabolic profile of indapamide sustained-release in patients with hypertension: data from three randomised double-blind studies. Drug Saf. 2001;24(15):1155-1165.
• 14. Suijk DLS, van Baar MJB, van Bommel EJM, et al. SGLT2 Inhibition and Uric Acid Excretion in Patients with Type 2 Diabetes and Normal Kidney Function. Clin J Am Soc Nephrol. 2022;17(5):663-671.