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Letters |18 June 2013

Chlorthalidone Versus Hydrochlorothiazide

Paula T. Einhorn, MD, MS; William C. Cushman, MD; Paul K. Whelton, MB, MD, MSc; for the ALLHAT Collaborative Research Group

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
  • From National Heart, Lung, and Blood Institute, Bethesda, Maryland; Veterans Affairs Medical Center, Memphis, Tennessee; and Tulane University, New Orleans, Louisiana.

    Disclaimer: Dr. Einhorn is a full-time employee of the National Heart, Lung, and Blood Institute. The views expressed in this letter do not necessarily represent the views of the National Heart, Lung, and Blood Institute; National Institutes of Health; or any other government entity.

    Acknowledgment: The authors acknowledge scientific input from Drs. Jeffrey Cutler, Barry Davis, and Jackson Wright and administrative assistance from Dr. Ellen Breckenridge. The ALLHAT Collaborative Research Group was supported by contracts NO1-HC-35130 and HHSN268201100036C with the National Heart, Lung, and Blood Institute. The ALLHAT investigators acknowledge study medications contributed by Pfizer (amlodipine and doxazosin), AstraZeneca (atenolol and lisinopril), and Bristol-Myers Squibb (pravastatin) and financial support provided by Pfizer.

    Potential Conflicts of Interest: Dr. Cushman: Consultancy: Novartis, Takeda, AstraZeneca, Merck, Daiichi-Sankyo; Other: Dr. Cushman has received honoraria from Novartis and Takeda.

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TO THE EDITOR:
We would like to clarify that the main results paper of ALLHAT (1) included information on serum potassium levels and supplementation by randomized treatment group (chlorthalidone, n = 15 255; amlodipine, n = 9048; lisinopril, n = 9054; and doxazosin, n = 9061). ALLHAT also explored the clinical significance of incident hypo- and hyperkalemia (2). Similar to Dhalla and coworkers’ findings (3), in our practice-based trial, severe hypokalemia (potassium levels <3.2 mmol/L, regardless of whether it was clinically apparent) was relatively uncommon (3.2% at 1-year follow-up in the chlorthalidone group; median dose, 19.0 mg/d).
Dhalla and associates report an incidence of hospitalizations with hypokalemia among patients receiving chlorthalidone of about 0.7% at year 1 (modal dose [m-dose], 25.0 mg/d) versus about 0.4% for those taking HCTZ (m-dose, 12.5 mg/d). Most would consider this dose of chlorthalidone to be 4-fold more potent than the 12.5 mg/d m-dose of HCTZ (4). Median follow-up was less than 1 year, with fewer than 15% of patients followed for 5 years (3).
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Einhorn PT, Cushman WC, Whelton PK, for the ALLHAT Collaborative Research Group. Chlorthalidone Versus Hydrochlorothiazide. Ann Intern Med. 2013;158:922–923. doi: 10.7326/0003-4819-158-12-201306180-00018

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Published: Ann Intern Med. 2013;158(12):922-923.

DOI: 10.7326/0003-4819-158-12-201306180-00018

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