2 minutes reading
Source/Disclosures Posted by: Source: Ishani A, et al. LBS.01: The Main Event: Changing Clinical Practice. Presented at: American Heart Association Scientific Sessions; November 5-7, 2022; Chicago (hybrid meeting). Disclosures: Ishani reports no relevant financial disclosures.
ADD SUBJECT TO EMAIL NOTIFICATIONS Receive an email when new articles are published Enter your email address to receive an email when new articles are published on . ” data-action=subscribe> Subscribe We were unable to process your request. Please try again later. If you continue to experience this problem, please contact [email protected] Back to Healio CHICAGO — Among older veterans with hypertension, there was no difference in the incidence of major adverse cardiovascular events after treatment with hydrochlorothiazide compared with chlorothiazide, new research shows. In the Diuretic Comparison Program, “chlorthalidone did not reduce the incidence of a major cardiovascular outcome or noncancer death compared with hydrochlorothiazide at doses commonly used in clinical practice, namely hydrochlorothiazide 25 mg or chlorothiazide 12.5 mg,” Areef Ishani, director MD, primary and specialty care at VA Minneapolis Health Care, director of specialty care at the VA Midwest Health Care Network, and vice chair and professor of medicine at the University of Minnesota, Minneapolis, said during a presentation at the American Heart Association Scientific Sessions. “Subgroup analyzes suggested a difference in primary outcome due to the presence or absence of prior stroke or MI.” Among older veterans with hypertension, there was no difference in the incidence of major adverse cardiovascular events after treatment with hydrochlorothiazide compared with chlorthalidone. Source: Adobe Stock The Diuretic Comparison Project was a point-of-care clinical trial conducted in a real-world setting. “We undertook this study as the first large randomized controlled trial comparing chlorthalidone with hydrochlorothiazide,” Ishani said. Researchers enrolled 13,523 US veterans aged at least 65 years with a recent systolic BP of 120 mm Hg or higher who were already taking hydrochlorothiazide 25 mg or 50 mg (mean age, 72 years, 97% male, 77% white, 45% rural) . Ninety-five percent of veterans were on low amounts of hydrochlorothiazide at baseline. For the intervention, veterans either continued hydrochlorothiazide or switched to chlorthalidone 12.5 mg. The researchers reported no difference in systolic BP or potassium between the hydrochlorothiazide and chlorthalidone groups over time. At a median follow-up of 2.4 years, the incidence of the primary outcome—time to first major adverse cardiovascular event, defined as stroke, myocardial infarction, noncancer death, hospitalization for acute heart failure or urgent revascularization, or unstable angina—was 10.4% in the chlorthalidone group compared with 10% in the hydrochlorothiazide group (HR = 1.04, 95% CI, 0.94–1.16, P = .4). There was also no difference in any of the individual components of the primary outcome, the researchers reported. In a prespecified subgroup analysis, chlorthalidone was associated with a 27% reduction in the primary outcome among patients with a history of MI or stroke (HR = 0.73; 95% CI, 0.57-0.94) compared with a 12% increase in patients without prior MI or stroke (HR = 1.12, 95% CI, 1-1.26; P for interaction = 0.035); Ishani said there was a slight increase in risk for laboratory-defined hypokalemia in the chlorthalidone group compared with the hydrochlorothiazide group (6% vs. 4.4%, HR = 1.38, 95% CI, 1.19-1, 6).
Report:
Perspective
Back to top
Manesh R. Patel, MD, FACC, FAHA, FSCAI
DCP was performed in the VA system and Dr. Ishani did an amazing job describing what they did in multiple VA systems to identify patient providers, consent them, and then consent patients verbally and randomly assign them to BP control or continuation of hydrochlorothiazide or chlorthalidone. They then used the electronic health record system to trace the events.
For CV events, there was no difference between chlorthalidone or hydrochlorothiazide, an important result for caregivers where we sometimes make decisions between these two commonly used agents.
There is no compelling reason, unless something else is going on differently or there are tolerability issues, to change the agent if they are already taking either hydrochlorothiazide or chlorthalidone. Most patients in the country are on hydrochlorothiazide and I think that informs our practice today.
Manesh R. Patel, MD, FACC, FAHA, FSCAI
Head, Departments of Cardiology and Clinical Pharmacology
Richard Sean Stack, MD Distinguished Professor
Duke University School of Medicine
Duke Clinical Research Institute
Disclosures: Patel reports no relevant financial disclosures.
ADD SUBJECT TO EMAIL NOTIFICATIONS Receive an email when new articles are published Enter your email address to receive an email when new articles are published on . ” data-action=subscribe> Subscribe We were unable to process your request. Please try again later. If you continue to experience this problem, please contact [email protected] Back to Healio
