Chlorthalidone is recommended over hydrochlorothiazide because it has a longer duration of effect 24 vs 612 hours and has been more extensively documented as effective in randomized clinical trials to reduce cardiovascular events and mortality. These findings do not support current recommendations to prefer chlorthalidone vs hydrochlorothiazide for hypertension treatment in firsttime. A new kind of veterans affairs cooperative study ann intern med. Feb 18, 2020 is hydrochlorothiazide hctz as effective and safe compared to chlorthalidone as a firstline therapy for hypertension. There are significant pharmacokinetic and pharmacodynamic differences between these diuretics. It is also used to prevent calciumbased kidney stones. Chlorthalidone ctd is the best diuretic for the treatment of hypertension, both in blood pressurelowering effi cacy and, most importantly, in prevention of. Abstractthiazide diuretics are one of the preferred pharmacologic treatments for hypertension. However, we wish to highlight that chlorthalidone ctd is the evidencebased and recommended antihypertensive diuretic, and should replace hctz in the trial to effectively compare efficacy against the ccb amlodipine. Recommended diuretic causes more serious side effects than similar hypertension drug, per recent ohdsi study forest plot of hazard ratio estimates and calibrated 95% confidence intervals for chlorthalidone versus hydrochlorothiazide for 55 safety and effectiveness outcomes for three databases and the metaanalysis. Chlortalidone, also known as chlorthalidone, is a diuretic medication used to treat high blood pressure, swelling including that due to heart failure, liver failure, and nephrotic syndrome, diabetes insipidus, and renal tubular acidosis.
Chlorthalidone linked to higher risk of electrolyte, kidney. Cohen abstractthiazide diuretics are one of the preferred pharmacologic treatments for hypertension. Chlorthalidone versus hydrochlorothiazide in hypertension. Pdf chlorthalidone versus hydrochlorothiazide for the. There has been a recent trend of using lower doses of these medications and change from chlorthalidone ctl use to hydrochlorothiazide hctz use.
In response, they sought to compare the effectiveness and safety of chlorthalidone and hydrochlorothiazide as firstline therapies for hypertension in realworld. Dec 01, 2015 chlorthalidone produces slightly greater reductions in blood pressure compared with hydrochlorothiazide hctz, but it is associated with greater declines in serum potassium levels. A simple difference in effective dose, with chlorthalidone known to have a greaterpermilligram potency for lowering blood pressure levels than hydrochlorothiazide, 6,7,27,28 could underlie some of the observed differences in toxicities, but our dosesensitivity analysis still revealed higher hypokalemia for chlorthalidone at a 1. Patients treated with chlorthalidone were more likely. The use of thiazide diuretics for the treatment of hypertension is strongly encouraged by current guidelines. Christina sommerauer1, andreas sonnichsen1, michael m. Comparison of cardiovascular and safety outcomes of. Chlorthalidone versus hydrochlorothiazide the american journal. Aug 24, 2020 background hypertension is a disease with significant clinical and socioeconomic consequences. To compare the effectiveness and safety of chlorthalidone and hydrochlorothiazide as firstline therapies for hypertension in realworld practice. Chlorthalidone versus hydrochlorothiazide for the treatment.
A more recent comparison of chlorthalidone versus hydrochlorothiazide on cvd outcomes included a. Differences in chlorthalidones mechanism of action vs. Comparative efficacy and safety of chlorthalidone and. Two ratios of potency for chlorthalidone vs hydrochlorothiazide. Pdf comparative efficacy and safety of chlorthalidone and. As noted in a letter by roush et al,17 this metaanalysis did not include more recent studies, such as allhat, that favor chlorthalidone over hydrochlorothiazide in network analysis. Chlorthalidone is recommended over hydrochlorothiazide because it has a longer duration of effect 24 vs 612 hours and has been more extensively documented as effective in randomized clinical trials to reduce cardiovascular. May 10, 20 prevention of recurrent calcium stone disease includes treatment with thiazide and thiazidetype diuretics to reduce urinary calcium uca levels, with the reduction in uca correlating with risk of stone recurrence. The thiazide diuretic hydrochlorothia zide and the thiazidelike diuretic chlortha lidone are two old drugs that are still useful.
Chlorthalidone compared with hctz for mace reduction mpr. Comparing clinical effectiveness and drug toxicity with. Chlorthalidone versus hydrochlorothiazide for treatment of primary arterial hypertension. Jan 21, 2021 chlorthalidone appears to be more effective than hydrochlorothiazide in reducing major adverse cardiovascular events mace in the long term, according to a recent study published in the journal. These findings indicate that chlorthalidone 25 mg is associated with a better antihypertensive response than hydrochlorothiazide 25 mg or 50 mg, without clinically. The results remained unchanged after multivariable logistic regression. How do hydrochlorothiazide and chlorthalidone compare for.
Hydrochlorothiazide versus chlorthalidone hypertension. Pdf chlorthalidone versus hydrochlorothiazide researchgate. They work to lower blood pressure by causing the kidneys to remove excess water and salt from the body through urine. Removes water from the body, which lowers blood pressure. Mar 01, 2018 the authors aim to compare the efficacy of amlodipine or hydrochlorothiazide hctz with an arb. Chlorthalidone produces slightly greater reductions in blood pressure compared with hydrochlorothiazide hctz, but it is associated with greater.
Chlorthalidone versus hydrochlorothiazide for hypertension in. Chlorthalidone is currently recommended as the preferred thiazide diuretic to treat hypertension, but no trials have directly compared risks and benefits. Chlorthalidone fda prescribing information, side effects. Thalitone chlorthalidone is a welltolerated water pill thats increasingly used to treat high blood pressure. Feb 01, 2020 chlorthalidone is indicated as adjunctive therapy in edema associated with congestive heart failure, hepatic cirrhosis, and corticosteroid and estrogen therapy. D2,3 from the department of family medicine, school of medicine, university of missouri kansas city, kansas city, mo.
Elliott has received research funding, honoraria, andor travel expenses from essentially every pharmaceutical company that makes, markets, or distributes antihypertensive drugs in the united states. Data from the legend largescale evidence generation and evaluation in a network of databases observational comparative cohort study were used for the present analysis. The network metaanalysis of randomized trials showed ctd reducing mace more than hctz, hazard ratio 0. In high blood pressure it is a preferred initial treatment. Chlorthalidone versus hydrochlorothiazide aha journals. Chlorthalidone and hydrochlorothiazide are often considered as interchangeable. Hctz on several secondary end points, total and lowdensity lipoprotein cholesterol, potassium, uric. Chlorthalidone may also be used for purposes not listed in this medication guide. To the editor hripcsak et al 1 compared cardiovascular and safety outcomes of chlorthalidone and hydrochlorothiazide in the treatment of patients with hypertension. Chlorthalidone and hydrochlorothiazide for treatment of. Microzide hydrochlorothiazide hctz is a welltolerated water pill thats often the firstchoice treatment for mild high blood pressure. Whether these pharmacokinetic and pharmacodynamic features cause differences in outcomes is not known. Hydrochlorothiazide versus chlorthalidone aha journals. Apr 20, 2020 chlorthalidone and hydrochlorothiazide are both diuretics also called water pills and belong to the thiazidelike and thiazide drug classes, respectively.
Comparison of newonset gout in adults prescribed chlorthalidone vs hydrochlorothiazide for hypertension liza wilson, pharm. Chlorthalidone has also been found useful in edema due to various forms of renal dysfunction, such as nephrotic syndrome, acute glomerulonephritis, and chronic renal failure. Antihypertensive efficacy of hydrochlorothiazide vs. Jan 11, 2019 hydrochlorothiazide hctz is one of the most commonly prescribed generic medications to lower blood pressure and protect people from these issues, but it turns out theres an alternative that might be more effective chlorthalidone. Hydrochlorothiazide for treatment of hypertension karyn springer, md, utah valley family medicine residency, provo, utah help desk answers provides answers to questions. Chlorthalidone compared with hydrochlorothiazide in reducing cardiovascular events. Key points chlorthalidone has a longer duration of action and a longer halflife than hydrochlorothiazide. Request pdf on may 5, 2014, jan c van blijderveen and others published risk of hyponatremia with diuretics. In a small, randomized, 8week crossover study comparing lowdose chlorthalidone to lowdose hydrochlorothiazide, chlorthalidone showed a decrease in nighttime blood pressure compared to hydrochlorothiazide.
Chlorthalidone, not hydrochlorothiazide, is the right. The authors summarize the literature comparing these two agents. They also examined the relative effects of chlorthalidone and. Chlorthalidone versus hydrochlorothiazide in hypertension treatment. Are there head to head studies of chlorthalidone versus. Chlorthalidone linked to higher risk of electrolyte. Diuretics have proven useful for the prevention of cardiovascular complications in addition to a long history of safety and efficacy. Pdf on jun 18, 20, alberto donzelli published chlorthalidone versus hydrochlorothiazide find, read and cite all the research you need on researchgate. However, greater nighttime blood pressure reduction, and. Chlorthalidone versus hydrochlorothiazide for the treatment of hypertension in older adults.
Chlorthalidone, the guidelinerecommended diuretic for lowering blood pressure, causes more serious side effects than hydrochlorothiazide, a similarly effective diuretic, according to a new study. Chlorthalidone is also used to treat high blood pressure hypertension. Combining angiotensin receptor blockers with chlorthalidone. Furthermore, if clinicians treat to similar blood pressure levels, then they may titrate the doses to levels with. Hydrochlorothiazide and chlorthalidone have been the 2 most commonly used diuretics in major clinical trials. Studies have found that chlorthalidone provides greater blood pressure lowering effects over a 24hour period than hctz.
Hydrochlorothiazide hctz and chlorthalidone ctld are with proven hypertensive effects. Hydrochlorothiazide hctz and chlorthalidone are both thiazide diuretics recommended as firstchoice options for treating high blood pressure because of their benefits on heart health and overall death rates. Chlorthalidone versus hydrochlorothiazide find, read and cite all the research you. Hydrochlorothiazide compared to chlorthalidone in reduction. Chlorthalidone may be more potent than hydrochlorothiazide in lowering blood pressure, but it also may be. States, but interest in chlorthalidone is increasing. Hydrochlorothiazide and chlorthalidone have been the 2 most.
The reduction in cardiovascular mortality and morbidity in patients treated for hypertension is directly related to the magnitude of blood pressure reduction. Comparison of newa onset gout in adults prescribed. Prescribers need to be made aware of the potential for chlorthalidone for patients with hypertension. Guidelinepreferred diuretic, chlorthalidone, causes more. Pdf even though hydrochlorothiazide hctz and chlorthalidone are frequently considered interchangeable antihypertensive agents, they appear to differ. Hydrochlorothiazide in hypertension disclosure information. Recommended diuretic causes more side effects than similar. Oct 11, 2019 chlorthalidone treats fluid retention in people with congestive heart failure, cirrhosis of the liver, or kidney disorders, or edema caused by taking steroids or estrogen. Jama intern med 2020 feb 17 a retrospective cohort study showed no major differences between the two drugs. Mean 24h blood cell count, white blood cell count, differential sbp was signi. Is hydrochlorothiazide hctz as effective and safe compared to chlorthalidone as a firstline therapy for hypertension.
Hydrochlorothiazide versus chlorthalidone evidence supporting their interchangeability barry l. Dec 01, 2012 the percentage of participants achieving target clinic blood pressure at week 6 was greater for the chlorthalidone versus hydrochlorothiazide combination 64. Chlorthalidone versus hydrochlorothiazide for hypertension. Hydrochlorothiazide is the most commonly used thiazide diuretic in the united states, but interest in chlorthalidone is increasing. The authors describe how chlorthalidone is currently recommended as the preferred thiazide diuretic to treat hypertension, but no trials have directly compared risks and benefits.
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