Risk of Benign Paroxysmal Positional Vertigo Modified by Diuretics-A Population-Level Case-Control Study

Abstract

Objective: This study aims to characterize diuretic use among patients with and without benign paroxysmal positional vertigo (BPPV) using a population-level database.

Study design: A case-control study.

Setting: TriNetX US Collaborative Network.

Methods: Subjects with ≥1 hospital visit between 2019 and 2024 were queried and stratified by age (18-44, 45-64, and 65+ years) and sex. Each cohort was then divided into those with/without BPPV. Patients with head trauma, middle/inner ear surgery, central vertigo, or migraine were excluded. The prevalence of diuretic use and vitamin D deficiency of each case cohort was compared against the control cohort of the same age/sex using Chi-square analysis. This stratification and analysis were repeated for patients with a vestibular disorder, as well as those with/without Ménière's disease (MD).

Results: Diuretic use was significantly more common in case cohorts than in control cohorts in the general population. In vestibular patients, thiazide and carbonic anhydrase inhibitor (CAI) use were more common in control cohorts, and loop use was less common. In MD patients, thiazide and loop use were more common in control cohorts, and CAI use did not differ significantly. In patients without MD, CAI use also did not differ, while thiazide and loop use were less common in control cohorts.

Conclusion: All diuretics may alter the risk of BPPV. Their influences can be favorable or unfavorable, depending on the individual patient's medical history. Their effects might relate more directly to the efficacy of each diuretic class rather than their specific mechanisms of action.

Keywords: benign paroxysmal positional vertigo; carbonic anhydrase inhibitor; loop diuretic; thiazide diuretic.

Figure 1

Hierarchy of criteria used for cohort generation for 4 different populations in the TriNetX US Collaborative Network database.

Figure 2

Odds ratios comparing the proportions of patients in the general population using a diuretic class in BPPV(+) cohorts versus age and sex‐matched BPPV(−) cohorts. “*” refers to statistically significant results with P < .05.

Figure 3

Odds ratios comparing the proportions of patients with a vestibular disorder using a diuretic class in BPPV(+) cohorts versus age and sex‐matched BPPV(−) cohorts. “*” refers to statistically significant results with P < .05.

Figure 4

Odds ratios comparing the proportions of patients with MD using a diuretic class in BPPV(+) cohorts versus age and sex‐matched BPPV(−) cohorts. “*” refers to statistically significant results with P < .05.

Figure 5

Odds ratios comparing the proportions of patients with a non‐MD peripheral vestibular disorder using a diuretic class in BPPV(+) cohorts versus age and sex‐matched BPPV(−) cohorts. “*” refers to statistically significant results with P < .05.