Efficacy of Low-Dose Chlorthalidone and Hydrochlorothiazide as Assessed by 24-h Ambulatory Blood Pressure Monitoring

Abstract

Treatment with low-dose chlorthalidone, 6.25 mg daily, significantly reduced mean 24-h ABP as well as daytime and nighttime BP. Due to its short duration of action, no significant 24-h ABP reduction was seen with HCTZ, 12.5 mg daily, which merely converted sustained hypertension into masked hypertension. Thus, low-dose chlorthalidone, 6.25 mg, could be used as monotherapy for treatment of essential hypertension, whereas low-dose HCTZ monotherapy is not an appropriate antihypertensive drug. (Comparative Evaluation of Safety and Efficacy of Hydrochlorothiazide CR with Hydrochlorothiazide and Chlorthalidone in Patients With Stage I Essential Hypertension; CTRI/2013/07/003793).

Trends in Antihypertensive Medication Use Among US Patients With Resistant Hypertension, 2008 to 2014

“…Although of a lower magnitude, Fontil et al 19 Our finding that hydrochlorothiazide remains the most commonly used thiazide diuretic is not surprising given its overwhelming use in the general hypertensive population. However, chlorthalidone use remains remarkably low in patients with TRH, despite evidence suggesting its superior BP-lowering ability and possible greater reductions in major adverse cardiovascular outcomes in most, [21][22][23][24] but not all, hypertensive populations. 25 In specific, chlorthalidone was present in only 6.4% of TRH episodes with any thiazide diuretic and only 5.3% of all TRH episodes, by the end of 2014.…”

Hydrochlorothiazide vs chlorthalidone, indapamide, and potassium‐sparing/hydrochlorothiazide diuretics for reducing left ventricular hypertrophy: A systematic review and meta‐analysis

“…It was predicted a priori that these CHIP diuretics would surpass HCTZ for reducing LVM based on the following: (a) Chlorthalidone is associated with reduced LVH when measured by electrocardiogram . (b) Chlorthalidone, indapamide, and PSD/HCTZ are each associated with lower blood pressure relative to HCTZ . (c) Chlorthalidone and triamterene/HCTZ are superior to HCTZ for reducing CVEs and CHF .…”

Which thiazide to choose—A “dynamic” question with a mundane answer?

“…3,4 In addition, some have questioned whether the pharmaceutical industry is complicit in perpetuating the current ambiguity by not recognizing CTD's superiority early on and developing it appropriately. 3,4 In addition, some have questioned whether the pharmaceutical industry is complicit in perpetuating the current ambiguity by not recognizing CTD's superiority early on and developing it appropriately.…”

“…3,4 In addition, some have questioned whether the pharmaceutical industry is complicit in perpetuating the current ambiguity by not recognizing CTD's superiority early on and developing it appropriately. While hard outcome measures remain wanting secondary data to continue to accrue, with the expert consensus seeming clear that practitioners should be using CTD instead of HCTZ.…”