Am Fam Physician. 2015 Dec 1;92(11):1015-1016.
Is chlorthalidone more effective than hydrochlorothiazide for treatment of hypertension?
Chlorthalidone produces slightly greater reductions in blood pressure compared with hydrochlorothiazide (HCTZ), but it is associated with greater declines in serum potassium levels. (Strength of Recommendation [SOR]: C, based on a meta-analysis of disease-oriented evidence.) Chlorthalidone lowers the risk of cardiovascular events about 18% more than HCTZ at the same achieved blood pressure. (SOR: B, based on a meta-analysis.)
In 2010, a meta-analysis of 137 randomized controlled trials (RCTs; N = 5,843) examined the effectiveness of chlorthalidone and HCTZ as monotherapy for hypertension.1 A total of 29 trials of chlorthalidone (N = 2,995; dose range = 12.5 to 200 mg, median 25 mg) and 108 trials of HCTZ (N = 2,848; dose range = 3 to 450 mg, median 33 mg) were analyzed based on dose and study duration (all less than one year). When all study durations were pooled, 12.5 to 25 mg of chlorthalidone produced a statistically greater reduction in systolic blood pressure compared with HCTZ (−24 mm Hg vs. −14 mm
REFERENCESshow all references
1. Ernst ME, Carter BL, Zheng S, Grimm RH Jr. Meta-analysis of dose-response characteristics of hydrochlorothiazide and chlorthalidone: effects on systolic blood pressure and potassium. Am J Hypertens. 2010;23(4):440–446....
2. Roush GC, Holford TR, Guddati AK. Chlorthalidone compared with hydrochlorothiazide in reducing cardiovascular events: systematic review and network meta-analyses. Hypertension. 2012;59(6):1110–1117.
3. Ernst ME, Carter BL, Goerdt CJ, et al. Comparative antihypertensive effects of hydrochlorothiazide and chlorthalidone on ambulatory and office blood pressure. Hypertension. 2006;47(3):352–358.
4. James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8) [published correction appears in JAMA. 2014;311(17):1809]. JAMA. 2014;311(5):507–520.
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