USA: A recent study has shown that chlorthalidone therapy improved blood-pressure control at 12 weeks in patients with advanced chronic kidney disease and poorly controlled hypertension. The study was published in the New England Journal of Medicine on November 5, 2021.
The study was conducted by Rajiv Agarwal and colleagues with an objective to determine the use of thiazide diuretics to treat hypertension in patients with advanced chronic kidney disease.
The study included patients with stage 4 chronic kidney disease and poorly controlled hypertension, as confirmed by 24-hour ambulatory blood pressure monitoring. 160 patients were randomly assigned in a ratio of 1:1 to receive chlorthalidone at an initial dose of 12.5 mg per day, with increases every 4 weeks if needed to a maximum dose of 50 mg per day, or placebo. The randomization was stratified according to the previous use of loop diuretics. The primary outcome was the change in 24-hour ambulatory systolic blood pressure from baseline to 12 weeks.
A total of 160 patients underwent randomization, of whom 121 (76%) had diabetes mellitus and 96 (60%) were receiving loop diuretics.
Key findings include:
At baseline, the mean (±SD) estimated glomerular filtration rate was 23.2±4.2 ml per minute per 1.73 m2 of body-surface area and the mean number of antihypertensive medications prescribed was 3.4±1.4.
At randomization, the mean 24-hour ambulatory systolic blood pressure was 142.6±8.1 mm Hg in the chlorthalidone group and 140.1±8.1 mm Hg in the placebo group and the mean 24-hour ambulatory diastolic blood pressure was 74.6±10.1 mm Hg and 72.8±9.3 mm Hg, respectively.
The adjusted change in 24-hour systolic blood pressure from baseline to 12 weeks was −11.0 mm Hg in the chlorthalidone group and −0.5 mm Hg in the placebo group.
The between-group difference was −10.5 mm Hg.
The percent change in the urinary albumin-to-creatinine ratio from baseline to 12 weeks was lower in the chlorthalidone group than in the placebo group by 50 percentage points.
Hypokalemia, reversible increases in serum creatinine level, hyperglycemia, dizziness, and hyperuricemia occurred more frequently in the chlorthalidone group than in the placebo group.
The researchers concluded, "Among patients with advanced chronic kidney disease and poorly controlled hypertension, chlorthalidone therapy improved blood-pressure control at 12 weeks as compared with placebo."
Reference:
The study titled, "Chlorthalidone for Hypertension in Advanced Chronic Kidney Disease," was published in the New England Journal of Medicine.
DOI: https://www.nejm.org/doi/full/10.1056/NEJMoa2110730