166 - Thiazide Throwdown: Hydrochlorothiazide vs. Chlorthalidone - The Ultimate Showdown for Hypertension Management

HelixTalk - Rosalind Franklin University's College of Pharmacy Podcast

Sean P. Kane, PharmD, BCPS

Health & Fitness, Medications, Rosalindfranklin, Rfums, Pharmacy, Pharmd, Pharmacist, Medicine, Drugs

5 • 644 Ratings

🗓️ 6 June 2023

⏱️ 38 minutes

🔗️ Recording | iTunes | RSS

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Summary

In this episode, we compare hydrochlorothiazide and chlorthalidone, but specifically from a cardiovascular outcomes perspective when used in patients with hypertension.

Key Concepts

Chlorthalidone, hydrochlorothiazide, and indapamide are available thiazide diuretics for treatment of hypertension; however, hydrochlorothiazide is the most commonly used agent.
Chlorthalidone is more potent in reducing blood pressure but also is associated with a higher risk of electrolyte abnormalities compared to HCTZ.
Recent studies for cardiovascular outcomes show that chlorthalidone is not better than HCTZ in preventing CV outcomes, but increases risk for hypokalemia, need for monitoring and even potassium supplementation.

References

Ishani A, Cushman WC, Leatherman SM, et al. Chlorthalidone vs. Hydrochlorothiazide for Hypertension–Cardiovascular Events. N Engl J Med 2022; 387:2401-2410. DOI: 10.1056/NEJMoa2212270. https://www.nejm.org/doi/full/10.1056/NEJMoa2212270
Akbari P, Khorasani-Zadeh A. Thiazide Diuretics. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532918/

Transcript

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0:00.0	Welcome to Helix Talk, an educational podcast for healthcare students and providers covering real-life clinical pearls, professional pharmacy topics, and drug therapy discussions.
0:11.0	This podcast is provided by pharmacists and faculty members at Rosal Franklin University College of Pharmacy.
0:17.0	This podcast contains general information for educational purposes only. This is not professional
0:22.4	advice and should not be used in lieu of obtaining advice from a qualified health care provider.
0:27.2	And now on to the show. Welcome to Helix Talk episode 166. I'm your co-host, Dr. Kane.
0:35.9	And I'm Dr. Patel. And the title of today's episode is
0:39.4	Thyazide Therodown, Hydrochlorothiozide versus Chlorothalodone, the ultimate showdown for hypertension
0:45.8	management. And Dr. Patel, obviously today we're talking about a newer trial that was published in the New England
0:51.6	Journal of Medicine, which is linked in the show notes, that compared chloralidone versus hydrochlorathydezide. And specifically, we're going to be
0:58.9	focusing on the cardiovascular outcomes that are seen in this trial. And this has been a hotly
1:04.9	debated topic for a long time. So it's kind of nice that we have some more clarity for this topic.
1:10.4	Yeah, there has certainly
1:11.4	been some abs and flow when it comes through the comparison of these two agents. But let's get
1:17.5	started with setting a stage with a case. Let's say KW is your patient. He is a 75-year-old male.
1:25.1	Past medical history is significant for hypertension, hepatopidemia, and osteoarthritis.
1:30.3	Here for medical rel, let's visit.
1:31.9	The blood pressure here today is 139 over 84.
1:35.6	At home, he's been measuring, and it's been averaging 135 over 85.
1:40.2	The current anti-hypertensives are hydrochlorothiaseide, 25 milligrams daily, lysineopril 20 milligrams
1:46.0	daily, vatervastatin 20 milligrams daily for hypolepidemia, and then he takes the extended release
1:53.2	Tylenol for osteoarthritis pain.
1:56.4	The labs are okay.
	...

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