Reassurance

HCTZ provides better CV protection

HCTZ therapy is associated with reduced risk of CV events such as heart failure hospitalization, or urgent coronary revascularization for unstable angina.

The Diuretic Comparison Project

Aimed to provide a real-world assessment of the effectiveness of chlorthalidone as compared with hydrochlorothiazide.

Study Design

A multicenter, pragmatic, open-label, randomized trial in veterans with hypertension.

13,523 adults >= 65 years of age (97% men), recent SBP >= 120 mm Hg and on HCTZ

Randomization

To continue HCTZ or switch to chlorthalidone.

HCTZ, provides better CV protection than ACE inhibitors and CCBs

Thiazide diuretics, particularly HCTZ, preferred in the management of uncontrolled or stage II hypertension in patients with cardiovascular risk.

Diuretics provide better CV protection than Calcium Channel Blockers

Reassurance

BP Control

CV Protection

Safety

Right Dose

Guideline recommendations

Kidney Protection

Reference

Ishani A, Cushman WC, Leatherman SM, Lew RA, Woods P, Glassman PA, Taylor AA, Hau C, Klint A, Huang GD, Brophy MT. Chlorthalidone vs. hydrochlorothiazide for hypertension–cardiovascular events. New England Journal of Medicine. 2022 Dec 29;387(26):2401-10.

Suchard MA et al. Comprehensive comparative effectiveness and safety of first-line antihypertensive drug classes: a systematic, multinational, large-scale analysis. Lancet. 2019 Nov 16;394(10211):1816-1826.

Zhu J, Chen N, Zhou M, Guo J, Zhu C, Zhou J, Ma M, He L. Calcium channel blockers versus other classes of drugs for hypertension. Cochrane Database of Systematic Reviews 2022, Issue 1. Art. No.: CD003654. DOI: 10.1002/14651858.CD003654.pub6.