What question did this study set out to answer?

To compare the clinical effectiveness and drug toxicity of chlorthalidone and hydrochlorothiazide using 1:1 and 1:2 potency ratios.

December 15, 2014Journal of Clinical HypertensionOpen Access

Comparing Clinical Effectiveness and Drug Toxicity With Hydrochlorothiazide and Chlorthalidone Using Two Potency Ratios in a Managed Care Population

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertension (n=856). Intervention: Chlorthalidone vs. Hydrochlorothiazide 25 mg or 50 mg. Primary outcome: Goal systolic blood pressure achievement (p=<.05).

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Key result

Chlorthalidone 25 mg was associated with higher goal systolic blood pressure achievement (45.0%) compared with hydrochlorothiazide 25 mg (32.1%) or 50 mg (32.8%) (P<.05).

Why the study?

Does chlorthalidone 25 mg improve blood pressure reduction compared to hydrochlorothiazide 25 mg or 50 mg in hypertensive patients?

Population

856 patients in a managed care population initially prescribed chlorthalidone or hydrochlorothiazide.

Comparison

Chlorthalidone 25 mg vs Hydrochlorothiazide 25 mg or hydrochlorothiazide…

Design

Cohort

Follow-up

at least 30 days

Authors

JSJoseph J. SaseenPreventive Cardiology VGVahram GhushchyanRegis University KNKavita NairUniversity of Colorado System

Discussion

Member takes

Implication

May support chlorthalidone preference in hypertension; leaves open confirmation by randomized trials.

Key Points

To compare the clinical effectiveness and drug toxicity of chlorthalidone and hydrochlorothiazide using 1:1 and 1:2 potency ratios.
Retrospective cohort analysis utilizing electronic health records and claims data in a managed care population.
Matched 214 patients initially prescribed chlorthalidone 25 mg with 428 patients prescribed hydrochlorothiazide 25 mg (1:1 potency ratio) and 214 patients prescribed hydrochlorothiazide 50 mg (1:2 potency ratio).
Mean blood pressure at ≥30 days was significantly lower with chlorthalidone 25 mg (132.2/74 mm Hg) compared with hydrochlorothiazide 25 mg (137.0/77.5 mm Hg) and hydrochlorothiazide 50 mg (138.6/78.5 mm Hg; P < .05 for all comparisons).
Goal systolic/diastolic blood pressure values were achieved in 45.0%/78.3% of chlorthalidone patients versus 32.1%/63.9% with hydrochlorothiazide 25 mg and 32.8%/68.9% with hydrochlorothiazide 50 mg (P < .05 for all comparisons).
Mean serum potassium was 3.94 mEq/L with chlorthalidone 25 mg versus 4.13 mEq/L with hydrochlorothiazide 25 mg (P < .01 vs chlorthalidone) and 3.96 mEq/L with hydrochlorothiazide 50 mg.

Study Design

Type

Cohort (n=856)

Structured PICO

Does chlorthalidone 25 mg improve blood pressure reduction compared to hydrochlorothiazide 25 mg or 50 mg in hypertensive patients?

Population

856 patients initially prescribed chlorthalidone 25 mg or hydrochlorothiazide 25 mg or 50 mg, evaluated at least 30 days after initial prescription.

Exposure

Chlorthalidone 25 mg

Comparator

Hydrochlorothiazide 25 mg (n=428) or hydrochlorothiazide 50 mg (n=214)

Outcome

Mean systolic and diastolic blood pressure values at least 30 days after initial prescriptionsurrogate

Main Result

Absolute Event Rate: 45% vs 32.1%

p-value: p=<.05

Chlorthalidone 25 mg is associated with a better antihypertensive response than hydrochlorothiazide 25 mg or 50 mg, without clinically significant differences in serum potassium.

Cite This Study

Saseen et al. (2014) conducted a cohort in Hypertension (n=856). Chlorthalidone vs. Hydrochlorothiazide 25 mg or 50 mg was evaluated on Goal systolic blood pressure achievement (p=<.05). Chlorthalidone 25 mg was associated with higher goal systolic blood pressure achievement (45.0%) compared with hydrochlorothiazide 25 mg (32.1%) or 50 mg (32.8%) (P<.05).

synapsesocial.com/papers/6a7c46e4d249c0c91c3be2fe https://doi.org/10.1111/jch.12453

Topics

Hypertension management

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December 15, 2014Journal of Clinical HypertensionOpen Access

Comparing Clinical Effectiveness and Drug Toxicity With Hydrochlorothiazide and Chlorthalidone Using Two Potency Ratios in a Managed Care Population

View Full Paper

Ask AI

Bookmark

Key result

Chlorthalidone 25 mg was associated with higher goal systolic blood pressure achievement (45.0%) compared with hydrochlorothiazide 25 mg (32.1%) or 50 mg (32.8%) (P<.05).

Why the study?

Does chlorthalidone 25 mg improve blood pressure reduction compared to hydrochlorothiazide 25 mg or 50 mg in hypertensive patients?

Population

856 patients in a managed care population initially prescribed chlorthalidone or hydrochlorothiazide.

Comparison

Chlorthalidone 25 mg vs Hydrochlorothiazide 25 mg or hydrochlorothiazide…

Design

Cohort

Follow-up

at least 30 days

Authors

JSJoseph J. SaseenPreventive Cardiology VGVahram GhushchyanRegis University KNKavita NairUniversity of Colorado System

Discussion

Member takes

Implication

May support chlorthalidone preference in hypertension; leaves open confirmation by randomized trials.

Key Points

To compare the clinical effectiveness and drug toxicity of chlorthalidone and hydrochlorothiazide using 1:1 and 1:2 potency ratios.
Retrospective cohort analysis utilizing electronic health records and claims data in a managed care population.
Matched 214 patients initially prescribed chlorthalidone 25 mg with 428 patients prescribed hydrochlorothiazide 25 mg (1:1 potency ratio) and 214 patients prescribed hydrochlorothiazide 50 mg (1:2 potency ratio).
Mean blood pressure at ≥30 days was significantly lower with chlorthalidone 25 mg (132.2/74 mm Hg) compared with hydrochlorothiazide 25 mg (137.0/77.5 mm Hg) and hydrochlorothiazide 50 mg (138.6/78.5 mm Hg; P < .05 for all comparisons).
Goal systolic/diastolic blood pressure values were achieved in 45.0%/78.3% of chlorthalidone patients versus 32.1%/63.9% with hydrochlorothiazide 25 mg and 32.8%/68.9% with hydrochlorothiazide 50 mg (P < .05 for all comparisons).
Mean serum potassium was 3.94 mEq/L with chlorthalidone 25 mg versus 4.13 mEq/L with hydrochlorothiazide 25 mg (P < .01 vs chlorthalidone) and 3.96 mEq/L with hydrochlorothiazide 50 mg.

Study Design

Type

Cohort (n=856)

Structured PICO

Does chlorthalidone 25 mg improve blood pressure reduction compared to hydrochlorothiazide 25 mg or 50 mg in hypertensive patients?

Population

856 patients initially prescribed chlorthalidone 25 mg or hydrochlorothiazide 25 mg or 50 mg, evaluated at least 30 days after initial prescription.

Exposure

Chlorthalidone 25 mg

Comparator

Hydrochlorothiazide 25 mg (n=428) or hydrochlorothiazide 50 mg (n=214)

Outcome

Mean systolic and diastolic blood pressure values at least 30 days after initial prescriptionsurrogate

Main Result

Absolute Event Rate: 45% vs 32.1%

p-value: p=<.05

Chlorthalidone 25 mg is associated with a better antihypertensive response than hydrochlorothiazide 25 mg or 50 mg, without clinically significant differences in serum potassium.

Cite This Study

synapsesocial.com/papers/6a7c46e4d249c0c91c3be2fe https://doi.org/10.1111/jch.12453

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

Topics

Hypertension management

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