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January 28, 2010American Journal of Hypertension

Meta-Analysis of Dose-Response Characteristics of Hydrochlorothiazide and Chlorthalidone: Effects on Systolic Blood Pressure and Potassium

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Why the study?

Does chlorthalidone produce equivalent reductions in systolic blood pressure and potassium compared to hydrochlorothiazide in the low-dose range of 12.5-25 mg?

Population

Patients in clinical trials evaluating hydrochlorothiazide or chlorthalidone monotherapies

Comparison

Chlorthalidone monotherapy vs Hydrochlorothiazide monotherapy

Design

Meta-analysis

Authors

MEMichael E. ErnstPreventive CardiologyBCBarry CarterGeneral / Preventive / LipidsSZShawn ZhengUniversity of California, San Francisco

Discussion

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Implication

Supports preferring chlorthalidone over HCTZ at low doses for SBP control; challenges equivalence assumptions and informs thiazide selection in trials.

Structured PICO

Does chlorthalidone produce equivalent reductions in systolic blood pressure and potassium compared to hydrochlorothiazide in the low-dose range of 12.5-25 mg?

P
Population
Patients in clinical trials evaluating hydrochlorothiazide or chlorthalidone monotherapies (pooled from 108 HCTZ trials and 29 chlorthalidone trials)
I
Intervention
Chlorthalidone monotherapy (dose-response curve including low-dose range of 12.5-25 mg)
C
Comparator
Hydrochlorothiazide (HCTZ) monotherapy (dose-response curve including low-dose range of 12.5-25 mg)
O
Outcome
Changes in systolic blood pressure (SBP) and potassiumsurrogate

At commonly prescribed low doses (12.5-25 mg), chlorthalidone provides greater systolic blood pressure reduction than hydrochlorothiazide, suggesting they are not interchangeable.

Cite This Study

Ernst et al. (2010) studied this question.

synapsesocial.com/papers/6a6ff1f4e5469ee92be0bd7fhttps://doi.org/10.1038/ajh.2010.1

Topics

Hypertension managementCardiovascular prevention
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