Chlorthalidone no better than hydrochlorothiazide for renal prevention in patients with hypertension: Study
USA: The choice between different diuretics for the management of hypertension has long been a subject of debate among healthcare professionals. A recent landmark study, known as the Diuretic Comparison Project (DCP), has brought new insights into this matter by comparing the renal outcomes of two commonly prescribed diuretics: chlorthalidone and hydrochlorothiazide.
The secondary analysis of the randomized DCP showed that chlorthalidone was no better than hydrochlorothiazide for reducing the incidence of major renal outcomes in hypertension patients. The findings were presented at a late-breaking presentation at the National Kidney Foundation (NKF) Spring Clinical Meeting.
Hypertension is a risk factor for the progression and development of chronic kidney disease (CKD). Previous studies have suggested a greater rate of eGFR progression and a greater CKD incidence with chlorthalidone (CTD) compared to hydrochlorothiazide (HCTZ). Previously, DCP has demonstrated cardiovascular outcomes among those with and without CKD (eGFR <60 mL/min) at baseline.
Areef Ishani, Minneapolis VAHCS, and University of Minnesota, Minneapolis, MN, United States, and colleagues aimed to evaluate renal outcomes comparing CTD and HCTZ in patients with hypertension.
In the DCP trial, the participants were randomized to continue HCTZ or switch to CTD at pharmacologically comparable doses. For the analysis, the primary outcome was CKD progression, defined as a doubling of creatinine, a terminal eGFR <10 mL/min, or kidney failure requiring treatment (KFRT).
Sensitivity analysis included an alternate definition of progression (40% reduction in eGFR, eGFR <10 mL/min or KFRT). Furthermore, the researchers evaluated the total slope of eGFR and incident CKD.
The researchers reported the following findings:
· 89% had a baseline and at least one follow-up creatinine measurement. The average baseline eGFR was 71 mL/min. The mean duration of follow-up was 2.4 years.
· There was no difference in the primary composite renal outcome between the CTD (3.6%) and the HCTZ groups (3.9%) (HR 0.94).
· There was no difference in the sensitivity outcome.
· The median total slope of eGFR change was not different between the CTD (-0.6) and the HCTZ group (-0.6 mL/min/yr).
· There was also no difference in the incidence of CKD between the CTD (16.5%) and the HCTZ groups (16.8%).
The findings revealed no difference in the renal composite outcome of doubling serum creatinine, an eGFR <10 mL/min, or KFRT between CTD and HCTZ treatment for a mean of 2.4 years in hypertensive patients. The slope of eGFR progression and the incidence of CKD was similar between the CTD and HCTZ groups.
As the healthcare landscape evolves, studies like the DCP play an important role in informing evidence-based practice and enhancing patient care. By elucidating the comparative effects of different diuretics on renal outcomes, this research empowers healthcare providers to make informed decisions that promote optimal health and well-being for individuals with hypertension.
Reference:
Ishani A, et al "Treatment with chlorthalidone vs hydrochlorothiazide and renal outcomes: the Diuretic Comparison Project (DCP)" NKF 2024; Poster 447.
