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Cited by 433Blood Pressure and Hypertension StudiesSodium Intake and HealthCardiovascular Health and Disease Prevention

Comparative Antihypertensive Effects of Hydrochlorothiazide and Chlorthalidone on Ambulatory and Office Blood Pressure

Ernst, Michael E., Carter, Barry L., Goerdt, Chris J., Steffensmeier, Jennifer J.G., Phillips, Beth Bryles, Zimmerman, M. Bridget, Bergus, George R.·2006·Hypertension
DOI 10.1161/01.hyp.0000203309.07140.d3
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Abstract

Low-dose thiazide-type diuretics are recommended as initial therapy for most hypertensive patients. Chlorthalidone has significantly reduced stroke and cardiovascular end points in several landmark trials; however, hydrochlorothiazide remains favored in practice. Most clinicians assume that the drugs are interchangeable, but their antihypertensive effects at lower doses have not been directly compared. We conducted a randomized, single-blinded, 8-week active treatment, crossover study comparing chlorthalidone 12.5 mg/day (force-titrated to 25 mg/day) and hydrochlorothiazide 25 mg/day (force-titrated to 50 mg/day) in untreated hypertensive patients. The main outcome, 24-hour ambulatory blood pressure (BP) monitoring, was assessed at baseline and week 8, along with standard office BP readings every 2 weeks. Thirty patients completed the first active treatment period, whereas 24 patients completed both. An order–drug–time interaction was observed with chlorthalidone; therefore, data from only the first active treatment period was considered. Week 8 ambulatory BPs indicated a greater reduction from baseline in systolic BP with chlorthalidone 25 mg/day compared with hydrochlorothiazide 50 mg/day (24-hour mean = −12.4±1.8 mm Hg versus −7.4±1.7 mm Hg; P =0.054; nighttime mean = −13.5±1.9 mm Hg versus −6.4±1.8 mm Hg; P =0.009). Office systolic BP reduction was lower at week 2 for chlorthalidone 12.5 mg/day versus hydrochlorothiazide 25 mg/day (−15.7±2.2 mm Hg versus −4.5±2.1 mm Hg; P =0.001); however, by week 8, reductions were statistically similar (−17.1±3.7 versus −10.8±3.5; P =0.84). Within recommended doses, chlorthalidone is more effective in lowering systolic BPs than hydrochlorothiazide, as evidenced by 24-hour ambulatory BPs. These differences were not apparent with office BP measurements.

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Authors
Ernst, M. E., Carter, B. L., Goerdt, C. J., Steffensmeier, J. J. G., Phillips, B. B., Zimmerman, M. B., & Bergus, G. R.
Affiliations
  • University of Iowa (US)
  • From the Division of Clinical and Administrative Pharmacy, College of Pharmacy (M.E.E., B.L.C., J.J.G.S., B.B.P.), Departments of Family Medicine (M.E.E., B.L.C., G.R.B.) and Internal Medicine (C.J.G.), Roy J. and Lucille A. Carver College of Medicine, and Department of Biostatistics, College of Public Health (M.B.Z.), University of Iowa; Pharmacy Department (J.J.G.S.), Veterans Affairs Medical Center; and Department of Pharmaceutical Care (B.B.P.), University of Iowa Hospitals and Clinics, Iowa...
ORCID
Venue
Hypertension
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2006-03
Volume
47
Issue
3
Pages
352-358
ISSN
  • 0194-911X (ISSN-L)
  • 1524-4563
DOI
10.1161/01.hyp.0000203309.07140.d3
OpenAlex
W2142937102
Cited by
433
References
46
Citations by year
2026: 10 · 2025: 8 · 2024: 2 · 2023: 5 · 2022: 17 · 2021: 15 · 2020: 14 · 2019: 16 · 2018: 17 · 2017: 18 · 2016: 24 · 2015: 21 · 2014: 32 · 2013: 47 · 2012: 44
FWCI
19.19
Type
journal article
Language
en
Open access
closed
Locations
  • Hypertension (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • American Association of Colleges of Pharmacy
  • American Foundation for Pharmaceutical Education
  • National Center for Research Resources (M01RR000059)
  • NIH Clinical Center
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
Keywords
hydrochlorothiazide, chlorthalidone, thiazide diuretics, antihypertensive efficacy, untreated hypertension, ambulatory blood pressure, office blood pressure, dose comparison, drug interchangeability
MeSH terms
Adult, Blood Pressure, Blood Pressure Determination, Chlorthalidone, Drug Administration Schedule, Drug Interactions, Female, Humans, Hydrochlorothiazide, Hypertension, Male, Middle Aged, Office Visits, Time Factors, Single-Blind Method, Cross-Over Studies, Blood Pressure Monitoring, Ambulatory, Sodium Chloride Symporter Inhibitors

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