Journal article
Long-Term Effects of Chlorthalidone Versus Hydrochlorothiazide on Electrocardiographic Left Ventricular Hypertrophy in the Multiple Risk Factor Intervention Trial
Hypertension (Dallas, Tex. 1979), Vol.58(6), pp.1001-U68
12/01/2011
DOI: 10.1161/HYPERTENSIONAHA.111.181248
PMCID: PMC3245686
PMID: 22025372
Abstract
Chlorthalidone (CTD) reduces 24-hour blood pressure more effectively than hydrochlorothiazide (HCTZ), but whether this influences electrocardiographic left ventricular hypertrophy is uncertain. One source of comparative data is the Multiple Risk Factor Intervention Trial, which randomly assigned 8012 hypertensive men to special intervention (SI) or usual care. SI participants could use CTD or HCTZ initially; previous analyses have grouped clinics by their main diuretic used (C-clinics: CTD; H-clinics: HCTZ). After 48 months, SI participants receiving HCTZ were recommended to switch to CTD, in part because higher mortality was observed for SI compared with usual care participants in H-clinics, whereas the opposite was found in C-clinics. In this analysis, we examined change in continuous measures of electrocardiographic left ventricular hypertrophy using both an ecological analysis by previously reported C-or H-clinic groupings and an individual participant analysis where use of CTD or HCTZ by SI participants was considered and updated annually. Through 48 months, differences between SI and usual care in left ventricular hypertrophy were larger for C-clinics compared with H-clinics (Sokolow-Lyon: -93.9 versus -54.9 mu V, P=0.049; Cornell voltage: -68.1 versus -35.9 mu V, P=0.019; Cornell voltage product: -4.6 versus -2.2 mu V/ms, P=0.071; left ventricular mass: -4.4 versus -2.8 g, P=0.002). At the individual participant level, Sokolow-Lyon and left ventricular mass were significantly lower for SI men receiving CTD compared with HCTZ through 48 months and 84 months of follow-up. Our findings on left ventricular hypertrophy support the idea that greater blood pressure reduction with CTD than HCTZ may have led to differences in mortality observed in the Multiple Risk Factor Intervention Trial. (Hypertension. 2011;58:1001-1007.). Online Data Supplement
Details
- Title: Subtitle
- Long-Term Effects of Chlorthalidone Versus Hydrochlorothiazide on Electrocardiographic Left Ventricular Hypertrophy in the Multiple Risk Factor Intervention Trial
- Creators
- Michael E. Ernst - University of IowaJames D. Neaton - University of Minnesota, DuluthRichard H. Grimm - University of Minnesota, DuluthGary Collins - University of Minnesota, DuluthWilliam Thomas - University of Minnesota, DuluthElsayed Z. Soliman - Wake Forest UniversityRonald J. Prineas - Wake Forest UniversityMultiple Risk Factor Intervention Trial Research Group
- Resource Type
- Journal article
- Publication Details
- Hypertension (Dallas, Tex. 1979), Vol.58(6), pp.1001-U68
- DOI
- 10.1161/HYPERTENSIONAHA.111.181248
- PMID
- 22025372
- PMCID
- PMC3245686
- NLM abbreviation
- Hypertension
- ISSN
- 0194-911X
- eISSN
- 1524-4563
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 11
- Grant note
- R01HL068140 / NATIONAL HEART, LUNG, AND BLOOD INSTITUTE; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Heart Lung & Blood Institute (NHLBI) R01-HL68140 / National Heart, Lung, and Blood Institute; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Heart Lung & Blood Institute (NHLBI)
- Language
- English
- Date published
- 12/01/2011
- Academic Unit
- Family and Community Medicine; Pharmacy Practice and Science
- Record Identifier
- 9984297444602771
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