-As will be presented in the December 2016 issue
, low dose therapy has considerable anti-hypertensive effect.
-Chlorthalidone is both more potent and longer acting than HCTZ. While the dose of HCTZ can be increased to match its potency, HCTZ must be given twice/day to ensure the 24hr anti-hypertensive effect of chlorthalidone.
-Since the duration of action of HCTZ is well under 24hrs, its anti-hypertensive effect wanes in the early morning hours, the time at which BP is highest and the most cardiovascular events occur
-Study limitations include the small number of patients randomized and the large standard deviation around a given BP reduction. The exclusion criteria are clinically relevant.
-Despite the above limitations, the results are consistent with the existing literature and generalizable to most hypertensives (apart those with a GFR < 30 cc/min).
I rarely use HCTZ and favor chlorthalidone or indapamide as my thiazide of choice.
-Further analysis can be found in the accompanying editorial in The Lancet that I coauthored (click here).