Key result
Chlorthalidone and indapamide are recommended over hydrochlorothiazide for hypertension due to HCTZ's lack of mortality benefit and potential to increase cardiovascular death.
Why the study?
Does hydrochlorothiazide reduce mortality or cardiovascular events compared to other diuretics or placebo in patients with high blood pressure?
Does hydrochlorothiazide reduce mortality or cardiovascular events compared to other diuretics or placebo in patients with high blood pressure?
Chlorthalidone and indapamide should be recommended over hydrochlorothiazide for the treatment of high blood pressure due to a lack of evidence for HCTZ and its potential for harm.
May support preferring chlorthalidone or indapamide over hydrochlorothiazide; leaves open confirmation from randomized mortality trials.
INTRODUCTION: Hydrochlorothiazide (HCTZ) has not been shown to reduce mortality or cardiovascular events when given as a single agent. In fact, HCTZ increased cardiovascular death and coronary artery disease (CAD) compared to placebo and usual care in 2 randomized trials, yet it is the most prescribed diuretic in the United States (U.S.). The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure does not recommend one thiazide diuretic over another. However, there are more clinical data for chlorthalidone and indapamide than HCTZ. AREAS COVERED: This review summarizes the differences between HCTZ, chlorthalidone and indapamide for pharmacological profile, surrogate marker data and clinical trial data. EXPERT OPINION: The use of the term 'thiazide diuretic' should be replaced with 'non-thiazide sulfonamide diuretic' for chlorthalidone and indapamide. Furthermore, chlorthalidone and indapamide, rather than HCTZ, should be recommended due to the lack of evidence and potential harm of the latter.
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James J. DiNicolantonio (2012) conducted a review in High Blood Pressure. Hydrochlorothiazide vs. Chlorthalidone and indapamide was evaluated. Chlorthalidone and indapamide are recommended over hydrochlorothiazide for hypertension due to HCTZ's lack of mortality benefit and potential to increase cardiovascular death.
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