Send us a text🧠 Clinical ContextHydrochlorothiazide (HCTZ) vs. Chlorthalidone—a classic cardio debate! ALHAT once hinted at chlorthalidone’s superiority, but did a modern head-to-head trial confirm that? Let's break it down.🧪 Study Snapshot: The HEADS-UP TrialDesign: Randomized, head-to-head trialPopulation: ~14,000 patients, age ≥65, already on HCTZ 25–50 mg + 1–2 antihypertensivesPrior CV disease: 15% had MI, stroke, or HFGroups:Continue HCTZSwitch to Chlorthalidone 12.5–25 mg dailyFollow-up: Median 2.4 years📈 OutcomesPrimary endpoint: Composite of MI, stroke, HF, urgent revascularization, or non-cancer death → Occurred in 10% of both groupsBP Control: No significant differenceHypokalemia:Chlorthalidone: 4.4%HCTZ: 6.0%💡 What About CKD?23% had GFR <60 at baseline, but…No strong data on severely reduced renal function for HCTZIn a 12-week placebo-controlled study, chlorthalidone lowered BP in GFR 15–30, but HCTZ didn’t have similar dataStill, in randomized trials: no difference in mortality or cardiovascular outcomes⚠️ Surprises & CaveatsDespite historical bias toward chlorthalidone, outcomes and BP control were equivalentHypokalemia was actually slightly lower with chlorthalidoneMore robust data is still needed for advanced CKD patients🧩 Clinical TakeawayDespite all the hype, chlorthalidone isn’t clearly superior. In practice, both meds perform similarly for hypertension control and cardiovascular outcomes in older adults. But if your patient has significantly impaired renal function, chlorthalidone may edge ahead—at least for now.💬 Bottom line? Choose the thiazide based on patient profile, tolerance, and renal function—not legacy dogma.

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