Chlorthalidone Versus Hydrochlorothiazide
Authors: Alberto Donzelli
Journal: Annals of Internal Medicine (2013)

Letters18 June 2013Chlorthalidone Versus HydrochlorothiazideAlberto Donzelli, MDAlberto Donzelli, MDFrom Azienda Sanitaria Locale Città di Milano, Milan, Italy.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-158-12-201306180-00017 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:In their Canadian observational cohort study, Dhalla and colleagues (1) concluded that, as typically prescribed in older adults, chlorthalidone is not (significantly) associated with fewer adverse CVEs or deaths than HCTZ (adjusted HR, 0.93 [95% CI, 0.81 to 1.06]) but is associated with a greater incidence of electrolyte abnormalities. They also concluded that HCTZ is safer. I disagree with the conclusion.The most recent and comprehensive systematic review and network meta-analysis (2) of randomized, controlled trials has clearly shown that chlorthalidone significantly reduced all CVEs more than HCTZ by 21% in the drug-adjusted analysis and 18% in ...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. 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 Scholar3. Jansen JP, Fleurence R, Devine B, Itzler R, Barrett A, Hawkins N, et al. Interpreting indirect treatment comparisons and network meta-analysis for health-care decision making: report of the ISPOR Task Force on Indirect Treatment Comparisons Good Research Practices: part 1. Value Health. 2011;14:417-28. [PMID: 21669366] CrossrefMedlineGoogle Scholar4. Ernst ME, Carter BL, Zheng S, Grimm RH. Meta-analysis of dose-response characteristics of hydrochlorothiazide and chlorthalidone: effects on systolic blood pressure and potassium. Am J Hypertens. 2010;23:440-6. [PMID: 20111008] CrossrefMedlineGoogle Scholar5. Stolarz-Skrzypek K, Kuznetsova T, Thijs L, Tikhonoff V, Seidlerová J, Richart T, et al; European Project on Genes in Hypertension (EPOGH) Investigators. Fatal and nonfatal outcomes, incidence of hypertension, and blood pressure changes in relation to urinary sodium excretion. JAMA. 2011;305:1777-85. [PMID: 21540421] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Alberto Donzelli, MDAffiliations: From Azienda Sanitaria Locale Città di Milano, Milan, Italy.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 Paula T. Einhorn , William C. Cushman , Paul K. Whelton , and 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 Metrics 18 June 2013Volume 158, Issue 12Page: 921-922KeywordsBlood pressureDrugsHospitalizationsNetwork analysisObservational studiesPotassiumPrevention, policy, and public healthSodiumSystematic reviewsSystolic pressure ePublished: 18 June 2013 Issue Published: 18 June 2013 Copyright & PermissionsCopyright © 2013 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...