Hyponatremia Induced by Angiotensin Converting Enzyme Inhibitors and Angiotensin Receptor Blockers-A Pilot Study

Abstract

Introduction: Hyponatremia, serum sodium <135 mmol/L, can result in neurological manifestation in acute cases, may lead to seizures and coma. Angiotensin Converting Enzyme Inhibitor (ACEI) and Angiotensin II Receptor Blockers (ARB) are drugs that have been commonly prescribed for the treatment of hypertension and cardiac diseases. It has become important to evaluate and investigate the incidence of hyponatremia on consumption of these drugs. Aim: To determine the susceptibility of patients on ACEI and ARB to hyponatremia and to ascertain the drug producing notable hyponatremia among ACEI and ARB. Materials and Methods: The study was conducted in a tertiary care hospital. Serum sodium levels were assayed in patients taking ACEI and ARB; 50 patients were recruited. The patient’s age, sex, drug dosage, frequency of the drug administration were collected using a proforma. Statistical analysis of data were performed using SPSS version 19.0. Results: Among all, 48% (24 out of 50) of the study population administered with ACEI and ARB developed hyponatremia. Predisposition to develop hyponatremia was high in males compared to females. Incidence of hyponatremia was 62.5% (10 out of 16) in the age group of 56-75 years. Though, incidence of hyponatremia was 54.5% (18 out of 33) in ACEI group compared to 35.2% (6 out of 17) in ARB group, but it was not statistically significant. The study also revealed that metosartan had a higher association with hyponatremia compared to other drugs. Conclusion: Hyponatremia was induced in nearly 50% of patients taking ACEI and ARB. The incidence of hyponatremia among patients on these two drugs did not show statistical variation. Metosartan showed a higher incidence of hyponatremia compared to enalapril, ramipril, captopril, telmisartan, losartan included in the study. This study revealed that monitoring of serum sodium level in the patients with ACEI and ARB administration will help to elude unexpected adverse reactions.

Keywords

• angiotensin converting enzyme inhibitors
• angiotensin ii receptor blockers
• lowering of sodium levels