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PMID: 18695387 Published · ppublish English Journal Article Review

Do thiazides worsen metabolic syndrome and renal disease? The pivotal roles for hyperuricemia and hypokalemia.

Current opinion in nephrology and hypertension ·Vol. 17 ·No. 5 ·2008-09-00 ·Pages 470-6

Reungjui S, Pratipanawatr T, Johnson RJ, Nakagawa T

Abstract

The aims of this article are to review the current controversies related to the use of thiazide diuretics as first-line treatment of hypertension and to discuss the causal roles for hyperuricemia and hypokalemia on the adverse consequences of thiazide usage. Thiazides significantly reduce morbidity and mortality in hypertensive subjects. There remains, however, debate about thiazide usage as first-line treatment of hypertension. This negative impact of thiazides may be partially attributed to the ability of thiazides to exacerbate features of metabolic syndrome or increase the risk for developing diabetes. Several clinical trials suggest that thiazide-induced hyperuricemia and hypokalemia may account for some of these negative effects. Thiazide treatment is also associated with a decline of renal function in spite of a lowering blood pressure. In this review, we discuss the clinical and experimental evidence supporting a potential role of hyperuricemia and hypokalemia on the development of renal injury and worsening of the metabolic syndrome. Hyperuricemia and hypokalemia may have pivotal roles in the exacerbation of the metabolic syndrome in response to thiazides. We propose that controlling serum uric acid and serum potassium could improve thiazide efficacy and also reduce its risk for inducing metabolic syndrome or diabetes.

MeSH Terms
Humans Hypertension/blood,drug therapy Hyperuricemia/chemically induced,metabolism Hypokalemia/chemically induced,metabolism Kidney/drug effects Kidney Diseases/metabolism,physiopathology Metabolic Syndrome/blood Sodium Chloride Symporter Inhibitors/adverse effects,therapeutic use
Chemicals
Sodium Chloride Symporter Inhibitors
Authors & Affiliations
4 authors, click to expand affiliations / ORCID
Reungjui Sirirat
Division of Nephrology, Khon Kaen University, Khon Kaen, Thailand.
Pratipanawatr Thongchai
Johnson Richard J
Nakagawa Takahiko
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Article Info
Journal
Current opinion in nephrology and hypertension
Abbr.
Curr Opin Nephrol Hypertens
ISSN
1062-4821
DOI
10.1097/MNH.0b013e328305b9a5
Published
2008-09-00
Pages
470-6
Language
English
Region
England
NLM ID
9303753
PMCID
PMC2903051
Subset
IM
Grants
NHLBI NIH HHS · R01 HL068607 · United States
NHLBI NIH HHS · R01 HL068607-01 · United States
External Links
PubMed source DOI: 10.1097/MNH.0b013e328305b9a5 PMC Full Text View journal details
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