17 Feb Hypertension Treatments with Chlorthalidone vs HCTZ: Cardiac and Safety Outcomes
MedicalResearch.com Interview with:
George Hripcsak, MD, MS
Vivian Beaumont Allen Professor of Biomedical Informatics
Chair, Department of Biomedical Informatics
Director, Medical Informatics Services
MedicalResearch.com: What is the background for this study?
Response: Diuretics are considered among the best drugs to treat hypertension, but there are no randomized studies to tell us which diuretic is best. Hydrochlorothiazide is the most frequently used diuretic for hypertension, but another drug, chlorthalidone, is gaining favor, with the most recent US hypertension guideline expressing a preference for it. Chlorthalidone is known to be longer acting and therefore perhaps more effective. Other (non-randomized) studies have been inconsistent, and some of them imply that chlorthalidone may be more effective. But other studies have shown that chlorthalidone may have more side effects.
MedicalResearch.com: What are the main findings?
Response: We carried out the largest and–we believe–most sophisticated non-randomized study comparing the two drugs, and we found little difference in effectiveness (preventing heart attacks, strokes, and heart failure) but we found that chlorthalidone produces more side effects, especially low potassium (almost three times as much) and other electrolyte disorders and kidney problems.
MedicalResearch.com: What should readers take away from your report?
Response: We believe that if you are already taking hydrochlorothazide, our study shows no reason to switch to chlorthalidone at this time. And if you are taking chlorthalidone, your physician should be monitoring your electrolytes and kidney function carefully.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: A large randomized study to compare the two drugs is currently in progress and may reveal more information in a few years. Even so, our study is reflective of what happens in real world practice.
Disclosures: This study was funded in part by the US National Institutes of Health and the National Science Foundation. George Hripcsak has received grant funding from Janssen Research through his university to support methods research not directly related to this study. Janssen did not have input in the design, execution, interpretation of results, or decision to publish.
Hripcsak G, Suchard MA, Shea S, et al. Comparison of Cardiovascular and Safety Outcomes of Chlorthalidone vs Hydrochlorothiazide to Treat Hypertension. JAMA Intern Med. Published online February 17, 2020. doi:10.1001/jamainternmed.2019.7454
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