What question did this study set out to answer?

To determine the comparative effects of chlorthalidone and spironolactone on muscle sympathetic nerve activity and evaluate the role of sympathetic activation in diuretic-induced insulin resistance.

January 22, 2009The Journal of Clinical Endocrinology & MetabolismOpen Access

Differential Effects of ChlorthalidoneVersusSpironolactone on Muscle Sympathetic Nerve Activity in Hypertensive Patients

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Why the study?

Does chlorthalidone compared to spironolactone affect muscle sympathetic nerve activity and insulin resistance in untreated hypertensive patients?

Population

23 untreated hypertensive patients

Comparison

Chlorthalidone 12.5-25 mg/d for 3 months vs Spironolactone 50-75 mg/d for 3 months

Design

RCT, randomized crossover

Follow-up

3 months per treatment arm

Authors

DMDileep V. MenonUniversity of the West Indies System DADebbie ArbiqueThe University of Texas Southwestern Medical Center ZWZhongyun WangNanjing Medical University

Discussion

Member takes

Implication

Chlorthalidone may worsen insulin resistance via sympathetic activation unlike spironolactone; challenges diuretic class equivalence beyond BP lowering.

Key Points

To determine the comparative effects of chlorthalidone and spironolactone on muscle sympathetic nerve activity and evaluate the role of sympathetic activation in diuretic-induced insulin resistance.
Conducted a randomized crossover study in 23 untreated hypertensive patients.
Administered chlorthalidone (12.5–25 mg/day) and spironolactone (50–75 mg/day), measuring muscle sympathetic nerve activity (SNA) at baseline, 1 month, and 3 months.
Evaluated ambulatory blood pressure, baroreflex sensitivity, and indices of insulin resistance at baseline and after 3 months of each treatment.
Both drugs produced comparable reductions in ambulatory blood pressure from baseline (11 ± 2 / 4 ± 2 mm Hg for chlorthalidone vs. 10 ± 2 / 4 ± 2 mm Hg for spironolactone).
Chlorthalidone increased SNA by 23% at 1 month (P < 0.01), which remained elevated at 3 months, whereas spironolactone had no effect on SNA in the same subjects.
Chlorthalidone significantly increased insulin resistance indices in correlation with rises in SNA, whereas spironolactone produced no changes in insulin resistance, and neither drug altered baroreflex control of SNA.

Structured PICO

Does chlorthalidone compared to spironolactone affect muscle sympathetic nerve activity and insulin resistance in untreated hypertensive patients?

Population

23 untreated hypertensive patients

Intervention

Chlorthalidone 12.5-25 mg/d for 3 months

Comparator

Spironolactone 50-75 mg/d for 3 months (crossover design)

Outcome

Muscle sympathetic nerve activity (SNA) at 1 and 3 monthssurrogate

Chlorthalidone, unlike spironolactone, causes persistent sympathetic activation and insulin resistance in hypertensive patients despite similar blood pressure lowering efficacy.

Cite This Study

Menon et al. (2009) studied this question.

synapsesocial.com/papers/6a8b2be995f0361a9ebeb905 https://doi.org/10.1210/jc.2008-2660

Topics

Hypertension management

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Implication

Chlorthalidone may worsen insulin resistance via sympathetic activation unlike spironolactone; challenges diuretic class equivalence beyond BP lowering.

Differential Effects of ChlorthalidoneVersusSpironolactone on Muscle Sympathetic Nerve Activity in Hypertensive Patients

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Topics

Differential Effects of ChlorthalidoneVersusSpironolactone on Muscle Sympathetic Nerve Activity in Hypertensive Patients

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Topics

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