Occurrence of Cardiovascular Events, Death Compared Between Thiazides

TUESDAY, Jan. 3, 2023 (HealthDay News) — For patients receiving thiazide diuretics, the occurrence of major cardiovascular outcome events or non-cancer-related deaths is no lower for those receiving chlorthalidone versus those receiving hydrochlorothiazide, according to a study published in the Dec. 29 issue of the New England Journal of Medicine.

Areef Ishani, M.D., from the University of Minnesota in Minneapolis, and colleagues randomly assigned 13,523 adults aged 65 years or older who had been receiving hydrochlorothiazide at 25 or 50 mg/day to continue therapy with hydrochlorothiazide or to switch to chlorthalidone at a daily dose of 12.5 or 25 mg (675 and 702 patients, respectively). At baseline, 12,781 of the patients (94.5 percent) had been prescribed hydrochlorothiazide at a dose of 25 mg/day.

The researchers observed little difference in the occurrence of primary outcome events (nonfatal myocardial infarction, stroke, heart failure resulting in hospitalization, urgent coronary revascularization for unstable angina, and non-cancer-related death) between the chlorthalidone group and the hydrochlorothiazide group (10.4 versus 10.0 percent). No between-group differences were seen in the occurrence of any of the components of the primary outcome. The chlorthalidone group had a higher incidence of hypokalemia than the hydrochlorothiazide group (6.0 versus 4.4 percent).

“Chlorthalidone did not lead to a lower incidence of major cardiovascular outcomes or non–cancer-related deaths than hydrochlorothiazide at doses commonly used in clinical practice,” the authors write.

One author disclosed financial ties to ReCor Medical.

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