Chlorthalidone Versus Hydrochlorothiazide
Authors: Paula T. Einhorn
Journal: Annals of Internal Medicine (2013)

Letters18 June 2013Chlorthalidone Versus HydrochlorothiazidePaula T. Einhorn, MD, MS, William C. Cushman, MD, and Paul K. Whelton, MB, MD, MSc, for the ALLHAT Collaborative Research GroupPaula T. Einhorn, MD, MSFrom National Heart, Lung, and Blood Institute, Bethesda, Maryland; Veterans Affairs Medical Center, Memphis, Tennessee; and Tulane University, New Orleans, Louisiana.Search for more papers by this author, William C. Cushman, MDFrom National Heart, Lung, and Blood Institute, Bethesda, Maryland; Veterans Affairs Medical Center, Memphis, Tennessee; and Tulane University, New Orleans, Louisiana.Search for more papers by this author, and Paul K. Whelton, MB, MD, MScFrom National Heart, Lung, and Blood Institute, Bethesda, Maryland; Veterans Affairs Medical Center, Memphis, Tennessee; and Tulane University, New Orleans, Louisiana.Search for more papers by this author, for the ALLHAT Collaborative Research GroupSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-158-12-201306180-00018 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We would like to clarify that the main results paper of ALLHAT (1) included information on serum potassium levels and supplementation by randomized treatment group (chlorthalidone, n = 15 255; amlodipine, n = 9048; lisinopril, n = 9054; and doxazosin, n = 9061). ALLHAT also explored the clinical significance of incident hypo- and hyperkalemia (2). Similar to Dhalla and coworkers’ findings (3), in our practice-based trial, severe hypokalemia (potassium levels <3.2 mmol/L, regardless of whether it was clinically apparent) was relatively uncommon (3.2% at 1-year follow-up in the chlorthalidone group; median dose, 19.0 mg/d).Dhalla and associates report an incidence of hospitalizations ...References1. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002;288:2981-97. [PMID: 12479763] CrossrefMedlineGoogle Scholar2. 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 Scholar3. 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 Scholar4. Ernst ME, Carter BL, Goerdt CJ, Steffensmeier JJ, Phillips BB, Zimmerman MB, et al. Comparative antihypertensive effects of hydrochlorothiazide and chlorthalidone on ambulatory and office blood pressure. Hypertension. 2006;47:352-8. [PMID: 16432050] CrossrefMedlineGoogle Scholar5. Carter BL, Einhorn PT, Brands M, He J, Cutler JA, Whelton PK, et al; Working Group from the National Heart, Lung, and Blood Institute. Thiazide-induced dysglycemia: call for research from a working group from the national heart, lung, and blood institute. Hypertension. 2008;52:30-6. [PMID: 18504319] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Paula T. Einhorn, MD, MS; William C. Cushman, MD; Paul K. Whelton, MB, MD, MScAffiliations: From National Heart, Lung, and Blood Institute, Bethesda, Maryland; Veterans Affairs Medical Center, Memphis, Tennessee; and Tulane University, New Orleans, Louisiana.Disclaimer: Dr. Einhorn is a full-time employee of the National Heart, Lung, and Blood Institute. The views expressed in this letter do not necessarily represent the views of the National Heart, Lung, and Blood Institute; National Institutes of Health; or any other government entity.Acknowledgment: The authors acknowledge scientific input from Drs. Jeffrey Cutler, Barry Davis, and Jackson Wright and administrative assistance from Dr. Ellen Breckenridge. The ALLHAT Collaborative Research Group was supported by contracts NO1-HC-35130 and HHSN268201100036C with the National Heart, Lung, and Blood Institute. The ALLHAT investigators acknowledge study medications contributed by Pfizer (amlodipine and doxazosin), AstraZeneca (atenolol and lisinopril), and Bristol-Myers Squibb (pravastatin) and financial support provided by Pfizer.Disclosures: Dr. Cushman: Consultancy: Novartis, Takeda, AstraZeneca, Merck, Daiichi-Sankyo; Other: Dr. Cushman has received honoraria from Novartis and Takeda. 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 Irfan A. Dhalla , Muhammad M. Mamdani , and David N. Juurlink Chlorthalidone Versus Hydrochlorothiazide George C. Roush , Theodore R. Holford , and Achuta K. Guddati 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 Metrics Cited byChlorthalidone Versus Hydrochlorothiazide in Hypertension Treatment: Do We Have the Evidence to Decide? 18 June 2013Volume 158, Issue 12Page: 922-923KeywordsBloodClinical trialsDrugsHealth care utilizationHeartHypertensionLungsPotassiumStroke ePublished: 18 June 2013 Issue Published: 18 June 2013 Copyright & PermissionsCopyright © 2013 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...