Thiazide Metabolic Effects — EECC MCQ
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Correct answer: C — Hyperuricaemia, electrolyte disturbance and dysglycaemia
Thiazide/thiazide-like diuretics have well-characterised metabolic effects: (1) Hyperuricaemia — reduced renal urate excretion (competing for the same organic anion transporter); can precipitate gout in predisposed individuals; (2) Hypokalaemia — increased potassium excretion in the collecting duct; (3) Hyponatraemia — impaired free water excretion; (4) Hypercalcaemia — enhanced calcium reabsorption in the DCT (this is why thiazides are used for hypercalciuria/nephrolithiasis); (5) Hyperglycaemia — reduced insulin secretion and sensitivity; (6) Dyslipidaemia — modest increases in LDL and triglycerides. These effects are largely dose-dependent — lower doses (indapamide 1.5 mg, chlorthalidone 12.5 mg, hydrochlorothiazide 12.5-25 mg) minimise metabolic derangement while maintaining antihypertensive efficacy. The 2024 ESC Hypertension Guidelines recommend low-dose thiazides as part of first-line SPC with monitoring.
Reference: ESC (2024): Hypertension Guidelines; BNF: https://www.nice.org.uk/guidance/ng219/chapter/recommendations