To the Editor Hripcsak et al1 compared cardiovascular and safety outcomes of chlorthalidone and hydrochlorothiazide in the treatment of patients with hypertension. Chlorthalidone is recommended over hydrochlorothiazide because it has a longer duration of effect (24 vs 6-12 hours) and has been more extensively documented as effective in randomized clinical trials to reduce cardiovascular events and mortality.2 Prior meta-analyses and observational comparisons suggest that chlorthalidone is superior in preventing cardiovascular events.3,4 However, to our knowledge there are no published randomized trials comparing chlorthalidone and hydrochlorothiazide; such a trial is ongoing in the US Veterans Affairs system, with results expected in 2023.5
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Moran AE, Whelton PK, Frieden TR. Chlorthalidone and Hydrochlorothiazide for Treatment of Patients With Hypertension. JAMA Intern Med. Published online June 22, 2020. doi:10.1001/jamainternmed.2020.1739
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