Head-to-Head Comparisons of Hydrochlorothiazide With Indapamide and Chlorthalidone Antihypertensive and Metabolic Effects

George C. Roush; Michael E. Ernst; John B. Kostis; Suraj Tandon; Domenic A. Sica

doi:10.1161/HYPERTENSIONAHA.114.05021

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Head-to-Head Comparisons of Hydrochlorothiazide With Indapamide and Chlorthalidone Antihypertensive and Metabolic Effects

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Head-to-Head Comparisons of Hydrochlorothiazide With Indapamide and Chlorthalidone Antihypertensive and Metabolic Effects

George C. Roush, Michael E. Ernst, John B. Kostis, Suraj Tandon and Domenic A. Sica

Hypertension (Dallas, Tex. 1979), Vol.65(5), pp.1041-U679

05/01/2015

DOI: 10.1161/HYPERTENSIONAHA.114.05021

PMID: 25733245

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Abstract

Hydrochlorothiazide (HCTZ) has often been contrasted with chlorthalidone, but relatively little is known about HCTZ versus indapamide (INDAP). This systematic review retrieved 9765 publications, and from these, it identified 14 randomized trials with 883 patients comparing HCTZ with INDAP and chlorthalidone on antihypertensive potency or metabolic effects. make fair comparisons, the dose of the diuretic in each ann was assigned 1 of 3 dose levels. In random effects meta-analysis, INDAP and chlorthalidone lowered systolic blood pressure more than HCTZ: -5.1 mmHg (95% confidence interval, -8.7 to -1.6); P=0.004 and -3.6 mmHg (95% confidence interval, -7.3 to 0.0); P=0.052, respectively. For both comparisons, there was minimal heterogeneity in effect across trials and no evidence for publication bias. The HCTZ INDAP contrast was biased in favor of greater HCTZ potency because of a much greater contribution to the overall effect from trials in which the HCTZ arm had a higher dose level than the INDAP arm. For the HCTZ INDAP comparison, no single trial was responsible for the overall result nor was it possible to detect significant modifications of this comparison by duration of follow-up, high- versus low-bias trials, or the presence or absence of background medications. There were no detectable differences between HCTZ and INDAP in metabolic adverse effects, including effects on serum potassium. In conclusion, these head-to-head comparisons demonstrate that, like chlorthalidone, INDAP is more potent than HCTZ at commonly prescribed doses without evidence for greater adverse metabolic effects.

Cardiovascular System & Cardiology

Life Sciences & Biomedicine

Peripheral Vascular Disease

Science & Technology

Details

Title: Subtitle: Head-to-Head Comparisons of Hydrochlorothiazide With Indapamide and Chlorthalidone Antihypertensive and Metabolic Effects
Creators: George C. Roush - UConn Health
Michael E. Ernst - University of Medicine and Dentistry of New Jersey
John B. Kostis - Robert Wood Johnson University Hospital
Suraj Tandon - UConn Health
Domenic A. Sica - Virginia Commonwealth University
Resource Type: Journal article
Publication Details: Hypertension (Dallas, Tex. 1979), Vol.65(5), pp.1041-U679
DOI: 10.1161/HYPERTENSIONAHA.114.05021
PMID: 25733245
NLM abbreviation: Hypertension
ISSN: 0194-911X
eISSN: 1524-4563
Publisher: Lippincott Williams & Wilkins
Number of pages: 16
Language: English
Date published: 05/01/2015
Academic Unit: Family and Community Medicine; Pharmacy Practice and Science
Record Identifier: 9984297455102771

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