Chlorthalidone Versus Hydrochlorothiazide
Authors: George C. Roush, Theodore R. Holford, Achuta K. Guddati
Journal: Annals of Internal Medicine (2013)

Letters18 June 2013Chlorthalidone Versus HydrochlorothiazideGeorge C. Roush, MD, MPH, Theodore R. Holford, PhD, and Achuta K. Guddati, MBBS, PhDGeorge C. Roush, MD, MPHFrom University of Connecticut School of Medicine and St. Vincent's Medical Center, Bridgeport, Connecticut; Yale University School of Public Health, New Haven, Connecticut; and Massachusetts General Hospital, Boston, Massachusetts.Search for more papers by this author, Theodore R. Holford, PhDFrom University of Connecticut School of Medicine and St. Vincent's Medical Center, Bridgeport, Connecticut; Yale University School of Public Health, New Haven, Connecticut; and Massachusetts General Hospital, Boston, Massachusetts.Search for more papers by this author, and Achuta K. Guddati, MBBS, PhDFrom University of Connecticut School of Medicine and St. Vincent's Medical Center, Bridgeport, Connecticut; Yale University School of Public Health, New Haven, Connecticut; and Massachusetts General Hospital, Boston, Massachusetts.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-158-12-201306180-00014 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Dhalla and colleagues’ (1) retrospective observational cohort study among older adults comparing chlorthalidone recipients with hydrochlorothiazide (HCTZ) recipients departs methodologically from other studies of antihypertensive drugs and health outcomes. First, there was no standardization in diagnosing cardiovascular events (CVEs). Second, the median follow-up for chlorthalidone recipients was only 255 days (8.4 months). The difference in CVEs between the 2 drugs does not manifest until about 9 months (Figure 1), implying that one half of the effect of chlorthalidone is not reflected in the hazard ratio (HR). Third, the analysis incorporated total mortality into the primary outcome, something ...References1. Dhalla IA, Gomes T, Yao Z, Nagge J, Persaud N, Hellings C, et al. Chlorthalidone versus hydrochlorothiazide for the treatment of hypertension in older adults: a population-based cohort study. Ann Intern Med. 2013;158:447-55. [PMID: 23552325] LinkGoogle Scholar2. Dorsch MP, Gillespie BW, Erickson SR, Bleske BE, Weder AB. Chlorthalidone reduces cardiovascular events compared with hydrochlorothiazide: a retrospective cohort analysis. Hypertension. 2011;57:689-94. [PMID: 21383313] CrossrefMedlineGoogle Scholar3. Alderman MH, Piller LB, Ford CE, Probstfield JL, Oparil S, Cushman WC, et al; Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial Collaborative Research Group. Clinical significance of incident hypokalemia and hyperkalemia in treated hypertensive patients in the antihypertensive and lipid-lowering treatment to prevent heart attack trial. Hypertension. 2012;59:926-33. [PMID: 22431578] CrossrefMedlineGoogle Scholar4. Roush GC, Holford TR, Guddati AK. Chlorthalidone compared with hydrochlorothiazide in reducing cardiovascular events: systematic review and network meta-analyses. Hypertension. 2012;59:1110-7. [PMID: 22526259] CrossrefMedlineGoogle Scholar5. Psaty BM, Lumley T, Furberg CD. Meta-analysis of health outcomes of chlorthalidone-based vs nonchlorthalidone-based low-dose diuretic therapies [Letter]. JAMA. 2004;292:43-4. [PMID: 15238589] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: George C. Roush, MD, MPH; Theodore R. Holford, PhD; Achuta K. Guddati, MBBS, PhDAffiliations: From University of Connecticut School of Medicine and St. Vincent's Medical Center, Bridgeport, Connecticut; Yale University School of Public Health, New Haven, Connecticut; and Massachusetts General Hospital, Boston, Massachusetts.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoChlorthalidone Versus Hydrochlorothiazide for the Treatment of Hypertension in Older Adults Irfan A. Dhalla , Tara Gomes , Zhan Yao , Jeff Nagge , Navindra Persaud , Chelsea Hellings , Muhammad M. Mamdani , and David N. Juurlink Chlorthalidone Versus Hydrochlorothiazide James J. DiNicolantonio , James H. O'Keefe , and Carl J. Lavie Chlorthalidone Versus Hydrochlorothiazide Robert G. Badgett Chlorthalidone Versus Hydrochlorothiazide Alberto Donzelli Chlorthalidone Versus Hydrochlorothiazide Paula T. Einhorn , William C. Cushman , and Paul K. Whelton , for the ALLHAT Collaborative Research GroupChlorthalidone Versus Hydrochlorothiazide Irfan A. Dhalla , Muhammad M. Mamdani , and David N. Juurlink Metrics Cited byChlorthalidone Versus Hydrochlorothiazide in Hypertension Treatment: Do We Have the Evidence to Decide?Chlorthalidone: Mechanisms of Action and Effect on Cardiovascular Events 18 June 2013Volume 158, Issue 12Page: 920KeywordsCohort studiesDiureticsDrugsHazard ratioHypertensionMortalityMyocardial infarctionNetwork analysisPotassiumRetrospective studies ePublished: 18 June 2013 Issue Published: 18 June 2013 Copyright & PermissionsCopyright © 2013 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...