Chlorthalidone Versus Hydrochlorothiazide for Treatment of Primary Arterial Hypertension

DOI: 10.3238/zfa.2015.0013-0017

german translation / full article

Andreas Sönnichsen, Michael M. Kochen, Christina Sommerauer

Keywords: Hydrochlorothiazide Chlorthalidone Hypertension

Summary: In a pragmatic literature research regarding the two diuretic substances hydrochlorothiazide (HCT) and chlorthalidone (CTDN) we looked into head-to-head comparisons, metaanalyses, systematic reviews and commentaries/editorials. HCT is the most commonly prescribed diuretic worldwide, also in Germany. Blood pressure lowering effectiveness and reduction of cardiovascular endpoints are well established, but most endpoint studies have been carried out with a higher dose than usually prescribed nowadays. CTDN has also been proven to be effective in lowering blood pressure and reducing cardiovascular events. Data of the MRFIT-trial suggest that it might be superior to HCT. Hospitalized patients on CTDN reached a 44 % reduction in mortality compared to patients prescribed HCT. These results, however, must be interpreted with care, because they are derived from post hoc subgroup analyses. They could not be confirmed in a large retrospective cohort study published in 2013 with 29.000 patients. In this study CTDN-patients revealed a higher risk for hospitalization due to hypokalemia. According to a recent Cochrane review maximum blood pressure lowering is already achieved with 12,5–25 mg CTDN daily while about a three times higher dose of HCT is necessary. For patients with normal kidney function an initial antihypertensive treatment with CTDN is a rational choice. A final answer to the question of clinical superiority can only be achieved by a large randomized controlled trial


(State: 16.01.2015)

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