Network meta-analysis of efficacy and safety of chlorthalidone and hydrochlorothiazide in hypertensive patients

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Abstract

Hypertension is a chronic condition leading to increased stress on the heart and blood vessels, a critical risk factor for clinically significant events such as myocardial infarction heart failure, stroke and death. Chlorthalidone and hydrochlorothiazide are first-line antihypertensive agents for most patients with hypertension. The aim of our meta-analysis was to compare the efficacy and safety of both therapies in patients with hypertension. Searches of electronic databases PubMed, MEDLINE, Scopus, PsycInfo and eLIBRARY.ru, were performed. We used network meta-analysis to combine direct and indirect evidence. Forest plots and closed loops depict estimated results from studies included in our meta-analysis. Of 1289 identified sources, only 37 were included in our meta-analysis. Our analysis has demonstrated a slight superiority for chlorthalidone regarding SBP and not statistically significant differences regarding DBP. Simultaneously, hydrochlorothiazide seems to be a safer choice of therapy, as evidenced by the levels of serum potassium. The two diuretics can be used interchangeably.

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Major Outcomes in High-Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)

The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group (2002)

Antihypertensive therapy is well established to reduce hypertension-related morbidity and mortality, but the optimal first-step therapy is unknown.

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Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group.

JL Probstfield (1991)

To assess the ability of antihypertensive drug treatment to reduce the risk of nonfatal and fatal (total) stroke in isolated systolic hypertension. Multicenter, randomized, double-blind, placebo-controlled. Community-based ambulatory population in tertiary care centers. 4736 persons (1.06%) from 447,921 screenees aged 60 years and above were randomized (2365 to active treatment, 2371 to placebo). Systolic blood pressure ranged from 160 to 219 mm Hg and diastolic blood pressure was less than 90 mm Hg. Of the participants, 3161 were not receiving antihypertensive medication at initial contact, and 1575 were. The average systolic blood pressure was 170 mm Hg; average diastolic blood pressure, 77 mm Hg. The mean age was 72 years, 57% were women, and 14% were black. --Participants were stratified by clinical center and by antihypertensive medication status at initial contact. For step 1 of the trial, dose 1 was chlorthalidone, 12.5 mg/d, or matching placebo; dose 2 was 25 mg/d. For step 2, dose 1 was atenolol, 25 mg/d, or matching placebo; dose 2 was 50 mg/d. Primary. Nonfatal and fatal (total) stroke. Secondary. Cardiovascular and coronary morbidity and mortality, all-cause mortality, and quality of life measures. Average follow-up was 4.5 years. The 5-year average systolic blood pressure was 155 mm Hg for the placebo group and 143 mm Hg for the active treatment group, and the 5-year average diastolic blood pressure was 72 and 68 mm Hg, respectively. The 5-year incidence of total stroke was 5.2 per 100 participants for active treatment and 8.2 per 100 for placebo. The relative risk by proportional hazards regression analysis was 0.64 (P = .0003). For the secondary end point of clinical nonfatal myocardial infarction plus coronary death, the relative risk was 0.73. Major cardiovascular events were reduced (relative risk, 0.68). For deaths from all causes, the relative risk was 0.87. In persons aged 60 years and over with isolated systolic hypertension, antihypertensive stepped-care drug treatment with low-dose chlorthalidone as step 1 medication reduced the incidence of total stroke by 36%, with 5-year absolute benefit of 30 events per 1000 participants. Major cardiovascular events were reduced, with 5-year absolute benefit of 55 events per 1000.

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Selected major risk factors and global and regional burden of disease.

Majid Ezzati, Alan Lopez, Anthony Rodgers … (2002)

Reliable and comparable analysis of risks to health is key for preventing disease and injury. Causal attribution of morbidity and mortality to risk factors has traditionally been in the context of individual risk factors, often in a limited number of settings, restricting comparability. Our aim was to estimate the contributions of selected major risk factors to global and regional burden of disease in a unified framework. For 26 selected risk factors, expert working groups undertook a comprehensive review of published work and other sources--eg, government reports and international databases--to obtain data on the prevalence of risk factor exposure and hazard size for 14 epidemiological regions of the world. Population attributable fractions were estimated by applying the potential impact fraction relation, and applied to the mortality and burden of disease estimates from the global burden of disease (GBD) database. Childhood and maternal underweight (138 million disability adjusted life years [DALY], 9.5%), unsafe sex (92 million DALY, 6.3%), high blood pressure (64 million DALY, 4.4%), tobacco (59 million DALY, 4.1%), and alcohol (58 million DALY, 4.0%) were the leading causes of global burden of disease. In the poorest regions of the world, childhood and maternal underweight, unsafe sex, unsafe water, sanitation, and hygiene, indoor smoke from solid fuels, and various micronutrient deficiencies were major contributors to loss of healthy life. In both developing and developed regions, alcohol, tobacco, high blood pressure, and high cholesterol were major causes of disease burden. Substantial proportions of global disease burden are attributable to these major risks, to an extent greater than previously estimated. Developing countries suffer most or all of the burden due to many of the leading risks. Strategies that target these known risks can provide substantial and underestimated public-health gains.

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Author and article information

Journal

Journal ID (nlm-ta): Blood Press Monit

Journal ID (iso-abbrev): Blood Press Monit

Journal ID (publisher-id): BPMJ

Title: Blood Pressure Monitoring

Publisher: Lippincott Williams & Wilkins

ISSN (Print): 1359-5237

ISSN (Electronic): 1473-5725

Publication date (Electronic): 04 September 2020

Publication date (Print): April 2021

Volume: 26

Issue: 2

Pages: 160-168

Affiliations

[a ]Department of Science, Tchaikapharma High Quality Medicines, Dimitrov Blvd

[b ]Department of Informatics, New Bulgarian University, 21 Montevideo St, Sofia

[c ]Department of Pharmacy, Medical University, Dean, Pleven, Bulgaria

Author notes

Correspondence to Elena Filipova, Department of Science, Tchaikapharma High Quality Medicines, Inc.,1 G.M. Dimitrov Blvd, 1172 Sofia, Bulgaria, Tel: +359 2 9603 561; fax: +3592 9603 703; e-mail: e.filipova.hq@ 123456tchaikapharma.com

Article

Accession ID: 00013

DOI: 10.1097/MBP.0000000000000486

PMC ID: 7932752

PubMed ID: 32909966

SO-VID: 0f874632-cb59-4a23-9e94-f908ad656039

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This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

History

Date received : 07 May 2020

Date accepted : 10 August 2020

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Keywords: blood pressure,chlorthalidone,clinical trial,controlled,diuretics,double blind,hydrochlorothiazide,hypertension,hypokalemia,hyponatremia,potassium,randomi*,sodium

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Keywords: blood pressure, chlorthalidone, clinical trial, controlled, diuretics, double blind, hydrochlorothiazide, hypertension, hypokalemia, hyponatremia, potassium, randomi*, sodium

Network meta-analysis of efficacy and safety of chlorthalidone and hydrochlorothiazide in hypertensive patients

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Most cited references 60

Major Outcomes in High-Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)

Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group.

Selected major risk factors and global and regional burden of disease.

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