Title : Safety and efficacy of chlorthalidone vs hydrochlorothiazide in hypertension
Abstract:
Hypertension is associated with an increased risk of complications and deaths from cardiovascular diseases. Thiazide diuretics, one of the first-line drugs for hypertension, include chlorthalidone and hydrochlorothiazide. This systemic review and meta-analysis aim to analyze the efficacy and safety of Chlorthalidone vs. Hydrochlorothiazide in Hypertension.
A comprehensive search was conducted in electronic databases like PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and SCOPUS using different MeSH words. Randomized controlled trials comparing Chlorthalidone vs. Hydrochlorothiazide and having data related to blood pressure were selected, and data was extracted using Rev Men 5.4.1; results were synthesized and analyzed.
Change in 24-hour mean ambulatory systolic blood pressure (BP) [mean difference (MD= -5.35 (-6.36, -4.34, p= < 0.00001, I² = 99%, five trials] and change in 24-hour mean ambulatory diastolic BP MD = -2.89 (-3.22, -2.55, p= < 0.00001, I² = 96%, five trials] were found to be decreased in chlorthalidone group. Similar results were seen in the change in clinic systolic BP [ MD= -4.93(-5.49, -4.38), p= < 0.00001, I² = 7%, 11 trials], change in clinic diastolic BP [ MD= -0.02 [-0.10, -0.06], p = 0.03; I² = 53%, nine trials]. Incidence of hypokalemia showed a significant risk with chlorthalidone [RR= 1.37 (1.19, 1.57), I² = 0%, p<0.0001, 8 trials] Chlorthalidone is more efficacious than hydrochlorothiazide in reducing blood pressure in hypertension patients with a significant risk of decrease in serum potassium levels.
Keywords: Chlorthalidone, Hydrochlorothiazide, Hypertension, Ambulatory blood pressure
Audience Take Away:
- Hypertension guideline considered chlorthalidone superior to the hydrochlorothiazide
- There is uncertainty about the superiority of one drug over another regarding efficacy and safety
- In this study it was found that for efficacy parameters chlorthalidone is better tha hydrochlorothiazide
- It was also found that chlorthalidone associated with more incidences of hypokalemia in comparison to hydrochlorothiazide
- Patients require better efficacy drug, need to be given chlorthalidone while hydrochlorothiazideshould be preferred in patients prone to hyporkalemia
