Chlorthalidone no better than hydrochlorothiazide for hypertension

Clinical Question

Is chlorthalidone or hydrochlorothiazide associated with a difference in the rate of major adverse cardiovascular events when used to treat hypertension?

Bottom line

Overall, there was no difference in cardiovascular outcomes when HCTZ was compared with chlorthalidone. There was a slightly higher risk of hypokalemia with chlorthalidone. The finding of better outcomes with chlorthalidone in the subset of patients with a previous MI or stroke is interesting but should be considered hypothesis-generating. 1b

Study design: Randomized controlled trial (nonblinded)

Funding: Government

Setting: Outpatient (any)


Mark H. Ebell, MD, MS
University of Georgia
Athens, GA

Discuss this POEM



Impact assessment

Very good


Hydrochlorothiazide comparé au clhorthalidone

Initialement j’avais commencé à prescrire le hydrochlorothiazide en résidence, puis en voyant des recommandations de préférer des médicaments de longue action, j’avais commencé à faire des nouvelles prescriptions de chlorthalidone. Vu qu’il n’y a pas de bénéfice au chlorthalidone, je vais reconsidérer mon choix dans le futur quand je recommanderais un diurétique.

Andrew Micheal Lacny

Blood pressure control

I am interested to know the results of blood pressure control in this group of patients. In my practice, I prescribe chlorthalidone to improve blood pressure control in more difficult patients and do not use it as first line diuretic in my HTN patients. The concept of choosing diuretic to improve incidence major events is more novel to myself.

Stanley Lofsky


I've been preferentially using chlorthalidone and indapamide to start off many hypertensives because of previous publications stating better CVS effects of the longer acting diuretics. It makes one dizzy to see such changes
Nevertheless we do have (until another paper comes out) the increased incidence of non melanoma skin malignancies associated with hydrochlorthiazide. So I'll stay where I am