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Comparative antihypertensive effects of hydrochlorothiazide and chlorthalidone on ambulatory and office blood pressure
Journal article   Open access   Peer reviewed

Comparative antihypertensive effects of hydrochlorothiazide and chlorthalidone on ambulatory and office blood pressure

Michael E Ernst, Barry L Carter, Chris J Goerdt, Jennifer J G Steffensmeier, Beth Bryles Phillips, M Bridget Zimmerman and George R Bergus
Hypertension (Dallas, Tex. 1979), Vol.47(3), pp.352-358
03/2006
DOI: 10.1161/01.HYP.0000203309.07140.d3
PMID: 16432050
url
https://doi.org/10.1161/01.HYP.0000203309.07140.d3View
Published (Version of record) Open Access

Abstract

Low-dose thiazide-type diuretics are recommended as initial therapy for most hypertensive patients. Chlorthalidone has significantly reduced stroke and cardiovascular end points in several landmark trials; however, hydrochlorothiazide remains favored in practice. Most clinicians assume that the drugs are interchangeable, but their antihypertensive effects at lower doses have not been directly compared. We conducted a randomized, single-blinded, 8-week active treatment, crossover study comparing chlorthalidone 12.5 mg/day (force-titrated to 25 mg/day) and hydrochlorothiazide 25 mg/day (force-titrated to 50 mg/day) in untreated hypertensive patients. The main outcome, 24-hour ambulatory blood pressure (BP) monitoring, was assessed at baseline and week 8, along with standard office BP readings every 2 weeks. Thirty patients completed the first active treatment period, whereas 24 patients completed both. An order-drug-time interaction was observed with chlorthalidone; therefore, data from only the first active treatment period was considered. Week 8 ambulatory BPs indicated a greater reduction from baseline in systolic BP with chlorthalidone 25 mg/day compared with hydrochlorothiazide 50 mg/day (24-hour mean = -12.4+/-1.8 mm Hg versus -7.4+/-1.7 mm Hg; P=0.054; nighttime mean = -13.5+/-1.9 mm Hg versus -6.4+/-1.8 mm Hg; P=0.009). Office systolic BP reduction was lower at week 2 for chlorthalidone 12.5 mg/day versus hydrochlorothiazide 25 mg/day (-15.7+/-2.2 mm Hg versus -4.5+/-2.1 mm Hg; P=0.001); however, by week 8, reductions were statistically similar (-17.1+/-3.7 versus -10.8+/-3.5; P=0.84). Within recommended doses, chlorthalidone is more effective in lowering systolic BPs than hydrochlorothiazide, as evidenced by 24-hour ambulatory BPs. These differences were not apparent with office BP measurements.
 Single-Blind Method Humans Middle Aged Hypertension - drug therapy Male Sodium Chloride Symporter Inhibitors - adverse effects Sodium Chloride Symporter Inhibitors - therapeutic use Drug Interactions Time Factors Sodium Chloride Symporter Inhibitors - administration & dosage Adult Female Blood Pressure - drug effects Hypertension - diagnosis Hydrochlorothiazide - adverse effects Chlorthalidone - therapeutic use Drug Administration Schedule Office Visits Chlorthalidone - adverse effects Hydrochlorothiazide - administration & dosage Hypertension - physiopathology Blood Pressure Determination - methods Cross-Over Studies Chlorthalidone - administration & dosage Blood Pressure Monitoring, Ambulatory Hydrochlorothiazide - therapeutic use

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