(0919) Diuretic Medications as a Risk Modifier for Benign Paroxysmal Positional Vertigo: A Population-Based Analysis

Introduction: Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common causes of vertigo, and the current understanding has related its development to serum calcium homeostasis. In order to identify potentially modifiable relevant risk factors for disease prevention, this population-based study utilized a federated electronic medical record (EMR) database to characterize diuretic use amongst BPPV and non-BPPV patients.

Methods: EMR data from the TriNetX US Collaborative Network was queried for subjects who were diagnosed with a vestibular disorder (ICD10: H81) in 2023. These patients were stratified by age (18-44, 45-64, 65+ years) and sex. Each cohort was then divided into those with and without a BPPV diagnosis (H81.1). Patients with prior documented head trauma (S02, S06, S09), middle or inner ear surgery, or migraine (G43) were excluded. The prevalence of pre-existing diuretic use and vitamin D deficiency (E55) of each BPPV cohort was compared against the non-BPPV cohort of the same age and sex using Fisher’s exact test.

Results: As expected, vitamin D deficiency had significantly greater prevalence among all patients with BPPV than those without (26.24% vs 18.77%, p < 0.0001). Loop diuretic use did not differ significantly between BPPV and non-BPPV populations (8.52% vs 8.41%, p = 0.6787). Thiazide use was significantly less common amongst BPPV patients (19.82% vs 30.31%, p < 0.0001), as was carbonic anhydrase inhibitor use (2.06% vs 19.55%, p < 0.0001).

Conclusions: Both thiazides and carbonic anhydrase inhibitors impact serum calcium and carbonate. Our results suggest that these diuretics are more commonly used amongst BPPV-free patients with vestibular disorders. Drugs of these classes may confer a protective effect against BPPV. Meanwhile, no significant difference was found with the use of loop diuretics.