Do you recommend transitioning elderly patients from thiazide diuretics to alternative agents when managing hypertension given the increased concern for hyponatremia in this patient population?

In short, no.

If hyponatremia from a thiazide occurs, which is rare (~2% among individuals in the intensive treatment arm of SPRINT), it is more likely to be in the first month after thiazide initiation. Hyponatremia occurring in an individual with chronic thiazide use very likely represents the pres...

I completely agree with Dr. @Dr. First Last's response. I'll add that the biggest problem with thiazides (and diuretics in general) in older patients is incontinence (predominantly in women) and increased nocturia (predominantly in men with BPH). Both of these adverse effects can substantially impai...