February 1, 2025Journal of Clinical HypertensionOpen Access

Comparison of Cardiovascular Outcomes Between Chlorthalidone and Hydrochlorothiazide in Hypertensive Patients

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Why the study?

Chlorthalidone and hydrochlorothiazide are widely used for hypertension management, but their comparative cardiovascular outcomes needed evaluation.

Does chlorthalidone improve cardiovascular outcomes compared to hydrochlorothiazide in hypertensive patients?

Structured PICO

Does chlorthalidone improve cardiovascular outcomes compared to hydrochlorothiazide in hypertensive patients?

Population

14,257 hypertensive patients (propensity matched to 1,606 per group), average age 61.8, 59.3% male, treated at Korea University Medical Center.

Intervention

Chlorthalidone

Comparator

Hydrochlorothiazide (1:1 propensity score matched)

Outcome

Major adverse cardiovascular events (MACE) at 3 yearscomposite

In a retrospective cohort of hypertensive patients, chlorthalidone and hydrochlorothiazide demonstrated comparable 3-year cardiovascular outcomes and safety profiles.

Implication

Comparable CV outcomes with either agent in hypertension; leaves open need for RCTs to confirm equivalence.

Abstract

Chlorthalidone (CLTD) and hydrochlorothiazide (HCTZ) are widely used thiazide diuretics for hypertension management. This study aimed to evaluate and compare the cardiovascular outcomes of patients treated with CLTD versus HCTZ. This multicenter, retrospective cohort study utilized data from the Korea University Medical Center, derived from electronic health records. A total of 14 257 hypertensive patients treated with either CLTD (n = 1920) or HCTZ (n = 12 337) were identified. Patients were matched 1:1 using propensity scores, resulting in 1606 patients in each treatment group. Demographic and clinical characteristics, incidence of major adverse cardiovascular events (MACE), and safety profiles were analyzed. Baseline characteristics after propensity score matching were well balanced between the two groups. The average age was 61.8 ± 14.6 years for CLTD users, with 59.3% being male. The 3-year MACE occurred in 1.2% of the CLTD group compared with 1.4% of the HCTZ group (hazard ratio 0.91, p = 0.77). For secondary outcomes, cardiovascular mortality was 0.2% in both groups (p = 0.92). Myocardial infarction occurred in 0.3% of CLTD users and 0.4% of HCTZ users (p = 0.65). The incidence of hypokalemia was 19.2% in the CLTD group versus 16.7% in the HCTZ group (p = 0.07). In conclusion, in hypertensive patients, CLTD and HCTZ showed comparable cardiovascular outcomes and safety profiles.