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

Abstract

Left ventricular hypertrophy develops in 36%‐41% of hypertensive patients and independently predicts cardiovascular events and total mortality. Moreover, drug‐induced reduction in left ventricular mass (LVM) correlates with improved prognosis. The optimal thiazide‐type diuretic for reducing LVM is unknown. Evidence regarding potency, cardiovascular events, sodium, and potassium suggested the hypothesis that “CHIP” diuretics (CHlorthalidone, Indapamide, and Potassium‐sparing diuretic/hydrochlorothiazide [PSD/HCTZ]) would reduce LVM more than HCTZ. Systematic searches of five databases were conducted. Among the 38 randomized trials, a 1% reduction in systolic blood pressure (SBP) predicted a 1% reduction in LVM, P = 0.00001. CHIP‐HCTZ differences in reducing LVM differed across trials (ie, heterogeneity), making interpretation uncertain. However, among the 28 double‐blind trials, heterogeneity was undetectable, and HCTZ reduced LVM (percent reduction [95% CI]) by −7.3 (−10.4, −4.2), P < 0.0001. CHIP diuretics surpassed HCTZ in reducing LVM: chlorthalidone −8.2 (−14.7, −1.6), P = 0.015; indapamide −7.5 (−12.7, −2.3), P = 0.005; and all CHIP diuretics combined −7.7 (−12.2, −3.1), P < 0.001. The comparison of PSD/HCTZ with HCTZ had low statistical power but favored PSD/HCTZ: −6.0 (−14.1, +2.1), P = 0.149. Thus, compared to HCTZ, CHIP diuretics had twice the effect on LVM. CHIP diuretics did not surpass HCTZ in reducing systolic or diastolic blood pressure: −0.3 (−5.0, +4.3) and −1.6 (−5.6, +2.4), respectively. The strength of evidence that CHIP diuretics surpass HCTZ for reducing LVM was high (GRADE criteria). In conclusion, these novel results have demonstrated that CHIP diuretics reduce LVM 2‐fold more than HCTZ among hypertensive patients. Although generally related to LVM, blood pressure fails to explain the superiority of CHIP diuretics for reducing LVM.

Diuretics and left ventricular hypertrophy regression: The relationship that we commonly forget

“…However, the recent meta‐analysis showed superiority of CHIP diuretics over hydrochlorothiazide and even renin‐angiotensin system inhibitors in the regression of LVH . The present study confirmed that CHIP diuretics surpassed hydrochlorothiazide in reducing LVM …”

“…The authors showed that a 1% decline in systolic blood pressure predicted a 1% decline in LV mass (LVM). Diastolic blood pressure decline also predicted LVM reduction; however, after adjustment for systolic blood pressure, diastolic blood pressure lost its predictive value as a predictor of LVM . The present meta‐analysis revealed that Chlorthalidone, indapamide, and potassium‐sparing diuretic (CHIP), alone or combined, were superior to hydrochlorothiazide for reducing LVM .…”

“…InQuery ID="q4" Text="AUTHOR: Please check and approve the edit made in the sentence “In this…reducing LVH.”" this issue, the Journal by Roush et al reported the importance of different diuretic groups in reducing LVH. Namely, the investigators compared hydrochlorothiazide to chlorthalidone, indapamide, and potassium‐sparing/hydrochlorothiazide diuretics and their role in the reduction in LVH in hypertensive patients . There are several points of this interesting study that deserve to be particularly discussed.…”

“…This meta‐analysis included 2299 patients who were treated with some of the mentioned diuretics . The authors showed that a 1% decline in systolic blood pressure predicted a 1% decline in LV mass (LVM).…”

“…7 There are several points of this interesting study that deserve to be particularly discussed.This meta-analysis included 2299 patients who were treated with some of the mentioned diuretics. 7 The authors showed that a 1% decline in systolic blood pressure predicted a 1% decline in LV mass (LVM). Diastolic blood pressure decline also predicted LVM reduction; however, after adjustment for systolic blood pressure, diastolic blood pressure lost its predictive value as a predictor of LVM.…”