Both thiazide drugs have been shown to be equally beneficial at preventing cardiovascular disease and hypertension in a sizable, real-world trial comparing them.
Diuretics are frequently used to treat hypertension, with thiazide-type diuretics being the primary drugs for the majority of patients. Chlorthalidone (CTD) and hydrochlorothiazide, two thiazide diuretics, were compared in a real-world clinical experiment (HCTZ). The results indicate that the medications are equally beneficial in preventing death from non-cancer causes and cardiovascular disease. More than one billion individuals worldwide and about half of all adults in the United States suffer from hypertension or high blood pressure. The disorder can make it more likely for you to develop renal, cardiac, and other ailments.
The primary investigator and director of the Primary Care and Specialty Care Integrated Care Community at the Minneapolis VA Health Care System, Dr. Areef Ishani, explains why the experiment was conducted.
“In 2020, approximately 1.5 million people were prescribed CTD compared to 11.5 million prescribed HCTZ, despite guideline recommendations. This discrepancy is possibly related to the belief that CTD has a greater risk of adverse effects for differences in cardiovascular outcomesâ€, said Ishani
Although moderate exercise, a good diet, and stress management can frequently lower blood pressure, drugs are occasionally required. Diuretics called thiazides are frequently used to reduce blood pressure.
Hypertension medications efficiency:
The Department of Veterans Affairs (VA) health system hosted this extensive clinical research.
Instead of a randomised control trial, it was a pragmatic trial. It assesses the efficacy of therapies within the conditions of everyday normal practise (RCT).
Since more than 60 years ago, thiazide diuretics have been used to treat hypertension. Despite the fact that certain research indicated that CTD was more efficient at lowering blood pressure.
The risk of adverse effects is higher with CTD, and doctors typically give HCTZ rather than CTD. This real-world trial looked at whether CTD prevented cardiovascular events in hypertensive patients better than HCTZ.
13,523 participants in all took part in the experiment.
All patients, who ranged in age from 65 to over and comprised about 97% men. They were taking HCTZ at doses of 25 mg or 50 mg daily to manage their hypertension. 6,767 participants were kept on HCTZ after randomization, while 6,756 switched to CTD.
High blood pressure and cardiovascular problems:
The first incidence of a nonfatal cardiovascular disease event or death unrelated to cancer was the trial’s primary endpoint.
Participants were monitored until they withdrew from the trial, passed away, or the trial came to an end.
A primary outcome event was encountered by 1,377 persons after a median follow-up of 2.4 years. The CTD group comprised 702 of them, while the HCTZ group comprised 675.
During the trial, the researchers only noticed a few minor adverse effects. People in the CTD group were more likely to have low potassium levels. With potassium supplements, this was rapidly resolved for the majority of persons.
When it came to preventing cardiovascular disease, such as heart attacks, strokes, heart failure, or lack of blood flow requiring medical attention, the two drugs were equally beneficial.
Equal efficacy from both hypertension drugs:
Therefore, doctors should take both CTD and HCTZ into account when prescribing medication to treat hypertension. However, it is encouraged that patients using either diuretic should continue taking it unless switching provides an additional advantage, such as allowing to lessen pill load.
Limitation of the trial:
One drawback is that male veterans outnumber female veterans by a wide margin. In fact, men made up over 97% of the study’s participants. Because of this, conclusions are difficult to extend to women.
Parvathy Sukumaran 
