James J. DiNicolantonio, PharmD; James H. O'Keefe, MD; Carl J. Lavie, MD
Potential Conflicts of Interest: None disclosed.
DiNicolantonio J., O'Keefe J., Lavie C.; Chlorthalidone Versus Hydrochlorothiazide. Ann Intern Med. 2013;158:920-921. doi: 10.7326/0003-4819-158-12-201306180-00015
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Published: Ann Intern Med. 2013;158(12):920-921.
TO THE EDITOR:
Dhalla and colleagues (1) state, “As typically prescribed, chlorthalidone in older adults was not associated with fewer adverse cardiovascular events or deaths than hydrochlorothiazide. However, it was associated with a greater incidence of electrolyte abnormalities, particularly hypokalemia.” This observational cohort study is contrary to a meta-analysis of 108 clinical trials, which indicated that reductions in potassium levels were considered equivalent between chlorthalidone and HCTZ when they were used in the dose range between 12.5 and 25.0 mg (2). In addition, data from MRFIT (Multiple Risk Factor Intervention Trial) indicate that chlorthalidone significantly reduces CVEs compared with HCTZ (P < 0.001) (3).
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