Comparison of cardiovascular outcomes between chlorthalidone and hydrochlorothiazide in hypertensive patients

초록

Background: Chlorthalidone and hydrochlorothiazide are widely used thiazide diuretics for hypertension management. This study aimed to evaluate and compare the cardiovascular outcomes of patients treated with chlorthalidone versus hydrochlorothiazide. Methods: This multicenter retrospective cohort study utilized data from our medical center, derived from electronic health records. A total of 14,257 hypertensive patients treated with either chlorthalidone (n = 1,920) or hydrochlorothiazide (n = 12,337) were identified. Patients were matched 1:1 using propensity scores, resulting in 1,606 patients in each treatment group. Demographic and clinical characteristics, incidence of major adverse cardiovascular events (MACE), and safety profiles were analyzed. Results: Baseline characteristics after propensity score matching were well balanced between the two groups. The average age was 61.8 ± 14.6 years for chlorthalidone users, with 59.3% being male. The 3-year MACE occurred in 1.2% of the chlorthalidone group compared with 1.4% of the hydrochlorothiazide group (hazard ratio 0.91, p = 0.77). For secondary outcomes, cardiovascular mortality was 0.2% in both groups (p = 0.92). Myocardial infarction occurred in 0.3% of chlorthalidone users and 0.4% of hydrochlorothiazide users (p = 0.65). The incidence of hypokalemia was 19.2% in the chlorthalidone group versus 16.7% in the hydrochlorothiazide group (p = 0.07). Conclusions: In hypertensive patients, chlorthalidone and hydrochlorothiazide showed comparable cardiovascular outcomes and safety profiles.