Comparison of Cardiovascular Outcomes Between Chlorthalidone and Hydrochlorothiazide in Hypertensive Patients

Area of Science:

• Cardiology
• Pharmacology
• Public Health

Background:

• Thiazide diuretics, including chlorthalidone (CLTD) and hydrochlorothiazide (HCTZ), are first-line treatments for hypertension.
• Comparative data on long-term cardiovascular outcomes between CLTD and HCTZ is limited.
• Understanding the comparative effectiveness and safety is crucial for clinical decision-making.

Purpose of the Study:

• To compare the cardiovascular outcomes of hypertensive patients treated with CLTD versus HCTZ.
• To evaluate the safety profiles of CLTD and HCTZ in a real-world clinical setting.
• To provide evidence-based guidance for selecting thiazide diuretics in hypertension management.

Main Methods:

• A multicenter, retrospective cohort study using electronic health records from Korea University Medical Center.
• Propensity score matching (1:1) was employed to balance baseline characteristics between CLTD and HCTZ groups.
• Analysis included major adverse cardiovascular events (MACE), cardiovascular mortality, myocardial infarction, and hypokalemia incidence.

Main Results:

• After propensity score matching, 1606 patients were included in each group (CLTD vs. HCTZ).
• The 3-year incidence of MACE was comparable: 1.2% for CLTD versus 1.4% for HCTZ (HR 0.91, p=0.77).
• Secondary outcomes, including cardiovascular mortality and myocardial infarction, and hypokalemia incidence were also similar between groups.

Conclusions:

• Chlorthalidone and hydrochlorothiazide demonstrate comparable efficacy in reducing cardiovascular events in hypertensive patients.
• Both thiazide diuretics exhibit similar safety profiles, including risks of hypokalemia.
• The findings support the use of either CLTD or HCTZ for hypertension management based on clinical context.