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Comment & Response
June 22, 2020

Chlorthalidone and Hydrochlorothiazide for Treatment of Patients With Hypertension

Author Affiliations
  • 1Resolve to Save Lives, Vital Strategies, New York, New York
  • 2Columbia University Irving Medical Center, New York, New York
  • 3Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
JAMA Intern Med. Published online June 22, 2020. doi:10.1001/jamainternmed.2020.1739

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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