Chlorthalidone – an underappreciated drug which may be one of the best diuretics in the management of hypertension Review article
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Published:
Sep 30, 2014
Keywords:
chlorthalidone, thiazide-like diuretic, arterial hypertension, treatment
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Abstract
Thiazide-like diuretics are recommended as first-line drugs in guidelines on the management of hypertension. Chlorthalidone, a thiazide-like diuretic, is an old drug with proven blood-pressure lowering efficacy and a beneficial effect on target organ damage and cardiovascular morbidity and mortality in patients with hypertension. Chlorthalidone is also used for other indications, including heart failure, ascites due to cirrhosis, and edema due to other causes, such as renal disease. In the current therapy of hypertension, however, chlorthalidone is used much less frequently than hydrochlorothazide or indapamide, and even less frequently than loop diuretics. This review summarizes data indicating that in comparison to hydrochlorothiazide, chlorthalidone is a longer-acting, more potent and more effective blood-pressure lowering drug, is safe and well tolerated in currently used small doses, and it may also have a more beneficial effect on cardiovascular events. Thus, chlorthalidone may still be one of the best diuretics in the treatment of hypertension, and its low use in current clinical practice suggests that physicians should be reminded about the benefits of this underappreciated drug.
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Gaciong , Z., & Jędrusik , P. (2014). Chlorthalidone – an underappreciated drug which may be one of the best diuretics in the management of hypertension. Medycyna Faktow (J EBM), 7(3(24), 44-53. Retrieved from https://www.journalsmededu.pl/index.php/jebm/article/view/2353
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References
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16. Ernst M.E., Neaton J.D., Grimm R.H. et al.; Multiple Risk Factor Intervention Trial Research Group: Long-term effects of chlorthalidone versus hydrochlorothiazide on electrocardiographic left ventricular hypertrophy in the Multiple Risk Factor Intervention Trial. Hypertension 2011; 58: 1001-1007.
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20. The ALLHAT officers and Coordinators for the ALLHAT Collaborative Research Group: Major cardiovascular events in hypertensive patients randomized to doxazosin vs. chlorthalidone: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2000; 283: 1967-1975.
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24. Multiple Risk Factor Intervention Trial Research Group: Coronary heart disease death, nonfatal acute myocardial infarction and other clinical outcomes in the multiple risk factor intervention trial. Am. J. Cardiol. 1986; 58: 1-13.
25. Dorsch M.P., Gillespie B.W., Erickson SR et al.: Chlorthalidone reduces cardiovascular events compared with hydrochlorothiazide: a retrospective cohort analysis. Hypertension 2011; 57: 689-694.
26. Dhalla I.A., Gomes T., Yao Z. et al.: Chlorthalidone versus hydrochlorothazide for the treatment of hypertension in older adults. Ann. Intern. Med. 2013; 158: 447-455.
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29. James P.A., Oparil S., Carter B.L. et al.: 2014 Evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014; 311: 507-520.
30. Weber M.A., Schiffrin E.L., White W.B. et al.: Clinical practice guidelines for the management of hypertension in the community: A statement by the American Society of Hypertension and the International Society of Hypertension. J. Clin. Hypertens. (Greenwich) 2014; 16: 14-26.
31. National Institute for Health and Clinical Excellence. Hypertension: clinical management of primary hypertension in adults (update). (Clinical guideline 127.) 2011
32. Go A.S., Bauman M.A., Coleman King S.M. et al.: An effective approach to high blood pressure control: A science advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention. J. Am. Coll. Cardiol. 2014; 63: 1230-1238.
33. Zillich A.J., Garg J., Basu S. et al.: Thiazide diuretics, potassium, and the development of diabetes: A quantitative review. Hypertension 2006; 48: 219-224.
2. Charakterystyka produktu leczniczego Hygroton.
3. Carter B.L., Ernst M.E., Cohen J.D.: Hydrochlorothazide versus chlorthalidone: evidence supporting their interchangeability. Hypertension 2004; 43: 4-9.
4. Cybulski J.: Chlortalidon. W: Główne leki kardiologiczne. Tom IV. Warszawa 1999.
5. Bengtsson C., Johnsson G., Sannerstedt R., Werko L.: Effect of different doses of chlorthalidone on blood pressure, serum potassium, and serum urate. BMJ 1975; 1: 197-199.
6. Kurtz T.W.: Chlorthalidone: don’t call it „thiazide-like” anymore. Hypertension 2010; 56: 335-337.
7. Wood R., Brown C., Lockette W.: Chlorthalidone decreases platelet aggregation and vascular permeability and promotes angiogenesis. Hypertension 2010; 56: 463-470.
8. Roush G.C., Holford T.R., Guddati A.K.: Chlorthalidone compared with hydrochlorothiazide in reducing cardiovascular events: systematic review and network meta-analyses. Hypertension 2012; 59: 1110-1117.
9. Mach R.S., Veyrat R.: Clinical experiences with some of the newer diuretics, especially chlorthalidone. Ann. N.Y. Acad. Sci. 1960; 88: 841-863.
10. Kakaviotos N., Finnerty F.A. Jr.: Comparison of chlorthalidone, a long acting antihypertensive and diuretic agent, with chlorothiazide. Am. J. Cardiol. 1962; 10: 570-574.
11. Materson B.J., Oster J.R., Michael U.F. et al.: Dose response to chlorthalidone in patients with mild hypertension: efficacy of a lower dose. Clin. Pharmacol. Ther. 1978; 24: 192-198.
12. SHEP Cooperative Research Group: Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 1991; 265: 3255-3264.
13. Ernst M.E., Carter B.L., Goerdt C.J. et al.: Comparative antihypertensive effects of hydrochlorothiazide and chlorthalidone on ambulatory and office blood pressure. Hypertension 2006; 47: 352-358.
14. Ernst M.E., Moser M.: Use of diuretics in patients with hypertension. N. Engl. J. Med. 2009; 361; 2153-2164.
15. Ernst M.E., Carter B.L., Zheng S., Grimm R.H.: Meta-analysis of dose-response characteristics of hydrochlorothiazide and chlorthalidone: effects on systolic blood pressure and potassium. Am. J. Hypertens. 2010; 23: 440-446.
16. Ernst M.E., Neaton J.D., Grimm R.H. et al.; Multiple Risk Factor Intervention Trial Research Group: Long-term effects of chlorthalidone versus hydrochlorothiazide on electrocardiographic left ventricular hypertrophy in the Multiple Risk Factor Intervention Trial. Hypertension 2011; 58: 1001-1007.
17. Liebson P.R., Grandits G.A., Dianzumba S. et al.; Treatment of Hypertension Study Research Group: Comparison of five antihypertensive monotherapies and placebo for change in left ventricular mass in patients receiving nutritional-hygienic therapy in the Treatment of Mild Hypertension Study (TOMHS). Circulation 1995; 91: 698-706.
18. Perry H.M. Jr, Davis B.R., Price T.R. et al.: Effect of treating isolated systolic hypertension on the risk of developing various types and subtypes of stroke: the Systolic Hypertension in the Elderly Program (SHEP). JAMA 2000; 284: 465-471.
19. The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group: Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic. JAMA 2002; 288: 2981-2997.
20. The ALLHAT officers and Coordinators for the ALLHAT Collaborative Research Group: Major cardiovascular events in hypertensive patients randomized to doxazosin vs. chlorthalidone: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2000; 283: 1967-1975.
21. Rosei E.A., Dal Palu C., Leonetti G. et al.: Clinical results of the Verapamil in Hypertension and Atherosclerosis Study. J. Hypertens. 1997; 15: 1337-1344.
22. Malacco E., Mancia G., Rappelli A. et al.: Treatment of isolated systolic hypertension: the SHELL study results. Blood Press 2003; 12: 160-167.
23. Neff K.M., Nawarskas J.J.: Hydrochlorothiazide versus chlorthalidone in the management of hypertension. Cardiology in Review 2010; 18: 51-56.
24. Multiple Risk Factor Intervention Trial Research Group: Coronary heart disease death, nonfatal acute myocardial infarction and other clinical outcomes in the multiple risk factor intervention trial. Am. J. Cardiol. 1986; 58: 1-13.
25. Dorsch M.P., Gillespie B.W., Erickson SR et al.: Chlorthalidone reduces cardiovascular events compared with hydrochlorothiazide: a retrospective cohort analysis. Hypertension 2011; 57: 689-694.
26. Dhalla I.A., Gomes T., Yao Z. et al.: Chlorthalidone versus hydrochlorothazide for the treatment of hypertension in older adults. Ann. Intern. Med. 2013; 158: 447-455.
27. Mancia G., Fagard R., Narkiewicz K. et al.: 2013 ESH/ESC Guidelines for the management of arterial hypertension. Eur. Heart J. 2013; 34: 2159-2219.
28. Widecka K., Grodzicki T., Narkiewicz K. et al.: Zasady postępowania w nadciśnieniu tętniczym – 2011 rok: wytyczne Polskiego Towarzystwa Nadciśnienia Tętniczego. Nadc. Tętn. 2011; 15: 211-235.
29. James P.A., Oparil S., Carter B.L. et al.: 2014 Evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014; 311: 507-520.
30. Weber M.A., Schiffrin E.L., White W.B. et al.: Clinical practice guidelines for the management of hypertension in the community: A statement by the American Society of Hypertension and the International Society of Hypertension. J. Clin. Hypertens. (Greenwich) 2014; 16: 14-26.
31. National Institute for Health and Clinical Excellence. Hypertension: clinical management of primary hypertension in adults (update). (Clinical guideline 127.) 2011
32. Go A.S., Bauman M.A., Coleman King S.M. et al.: An effective approach to high blood pressure control: A science advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention. J. Am. Coll. Cardiol. 2014; 63: 1230-1238.
33. Zillich A.J., Garg J., Basu S. et al.: Thiazide diuretics, potassium, and the development of diabetes: A quantitative review. Hypertension 2006; 48: 219-224.