Hypertension or high blood pressure is a medical condition ailing almost half the adult population in the world. The condition is prevalent in countries regardless of socioeconomic status. Hypertension receives massive attention from medical experts because it is closely linked to the development of cardiovascular conditions, stroke, and aneurysms.
Treatments for Hypertension
Different approaches have been developed to treat hypertension efficiently, the most popular one being lifestyle changes such as regular exercise, healthy eating, and dropping drinking and smoking. Proper management of stress is also recommended to prevent hypertension. Medical practitioners prescribe various medications for this condition when lifestyle changes are insufficient. Diuretics, beta-blockers, and ACE inhibitors are the common drugs that doctors consider for hypertension. Other health conditions are also taken into account before deciding the suitable medication.
Among diuretics, thiazide-type diuretics are more commonly recommended for patients in the initial stages of hypertension. Owing to its role in treating a large population of individuals with hypertension, a real-world clinical trial compared two thiazide diuretics, chlorthalidone (CTD) and hydrochlorothiazide (HCTZ), to ascertain their potency in preventing and managing the condition. Extensive studies confirmed that both drugs effectively prevent cardiovascular disease and non-cancer death.
The Real-World Scenario
According to Dr. Areef Ishani, principal investigator and director of the Minneapolis VA Health Care System’s Primary Care and Specialty Care Integrated Care Community, “In 2020, Medicare reported that approximately 1.5 million people were prescribed CTD compared to 11.5 million prescribed HCTZ, despite guideline recommendations.”
This led the experts to examine the disparity between the possible side effects and the observations in real-time because until then, it was believed that CTD posed a greater risk of adverse effects, whereas HCTZ is more commonly prescribed because previous studies suggested CTD as a better option for blood pressure control.
This study has brought to everyone’s attention that both diuretics have similar results when administered to patients. The 2020 study probed the greater side effects of CTD and why HCTZ is prescribed increasingly each day.
Understanding the Study
In a trial of 13,523 participants with hypertension, almost 97% were men, were aged 65 or over, and were being treated with HCTZ — 25 milligrams (mg) or 50 mg per day. With consent from the participants, they were allocated to continue treatment with HCTZ or switch to CTD.
Since existing research literature favors CTD, researchers had to confirm what prompted the physicians to administer HCTZ to their patients. The study deemed the occurrence of a nonfatal cardiovascular disease event or non–cancer-related death as the primary event, and the participants had to be checked on until the withdrawal from the trial, death, or the end of the trial.
After a follow-up of 2.4 years, 1,377 people experienced a primary outcome event. Of these, 702 were in the CTD group and 675 in the HCTZ group. Only a few side effects were recorded throughout the trial, but those in the CTD group were more likely to have low potassium levels.
As sufficient evidence that both medications are equally effective at preventing cardiovascular disease or non-cancer death, which include heart attack, stroke, heart failure, or lack of blood flow requiring medical intervention, the experts see no issue in prescribing one drug over the other.
