A Cup of Coffee – Is Your High Blood Pressure Medication Working?

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Many of us find that we end up with high blood pressure as we age. For some, it’s genetic, and for others, it’s lifestyle choices. We’ve all heard our doctors warn us to lose weight and exercise, and often medication is on the menu in the search for those healthy blood pressure numbers.

You can lead a horse to water, but you can’t make them drink, right? For those of us who have agreed to take medications in an effort to live not just as long as possible, but as healthy as possible at the same time, you may be interested in reading about a new article that was published on November 5th of this year.

The Two Drugs In Question

We are going to talk about two drugs, Chlorthalidone and Hydrochlorothiazide. Hydrochlorothiazide is available under the following different brand names: Microzide, HydroDiuril, Hydro, Esidrix, HCTZ, Oretic. Chlorthalidone is available under the following different brand names: Hygroton, Thalitone, and Chlorthalid.

What Are They Prescribed For Specifically?

Chlorthalidone is a prescription drug used to treat high blood pressure (hypertension). Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. It is also used to reduce extra salt and water in the body caused by conditions such as heart failure, liver disease, and kidney disease. Decreasing extra salt and water in the body help to decrease swelling (edema) and breathing problems caused by fluid in the lungs. Chlorthalidone is a “water pill” (diuretic). It increases the amount of urine you make, especially when you first start the medication. It also helps to relax the blood vessels so that blood can flow more easily.

Hydrochlorothiazide is used to treat high blood pressure. Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. Hydrochlorothiazide belongs to a class of drugs known as diuretics/”water pills.” It works by causing you to make more urine. This helps your body get rid of extra salt and water. This medication also reduces extra fluid in the body (edema) caused by conditions such as heart failure, liver disease, or kidney disease. This can lessen symptoms such as shortness of breath or swelling in your ankles or feet.

Are They The Same Then?

Apparently not, yet in some ways, yes? At least according to a study that was released on November 5th.

Medscape recently released information about a real-world study that was done, that indicated there was no difference in major cardiovascular outcomes with the use of two different diuretics — chlorthalidone or hydrochlorothiazide — in the treatment of hypertension.

Their article stated, “The Diuretic Comparison Project (DCP), which was conducted in more than 13,500 U.S. veterans age 65 years or over, showed almost identical rates of the primary composite endpoint, including myocardial infarction (MI), stroke, noncancer death, hospitalization for acute heart failure, or urgent revascularization, after a median of 2.4 years of follow-up.

“There was also no difference in any of the individual endpoints or other secondary cardiovascular outcomes.”

Interestingly enough, in the subgroup of patients who had a history of heart attack or stroke (who made up about 10% of the study population), there was a significant reduction in the primary endpoint with chlorthalidone, whereas those without a history of heart attack or stroke appeared to have an increased risk for primary outcome events while receiving chlorthalidone compared with those receiving hydrochlorothiazide.

NewMediaWire also published an article about this study, “Two common diuretics used to control blood pressure had no difference in cardiovascular outcomes, including death, according to late-breaking science research presented today at the American Heart Association’s Scientific Sessions 2022. The meeting, held in person in Chicago and virtually, Nov. 5-7, 2022, is a premier global exchange of the latest scientific advancements, research, and evidence-based clinical practice updates in cardiovascular science.“

Why Is This Important?

According to the American Heart Association’s Heart Disease and Stroke Statistics 2022 Update, nearly half of U.S. adults have high blood pressure, which is a leading cause of heart disease. Chlorthalidone and hydrochlorothiazide are diuretics that have been prescribed for more than 50 years and are considered the first-line treatments for high blood pressure.

Based on earlier studies and other research suggesting that chlorthalidone did a better job controlling blood pressure over 24 hours compared to hydrochlorothiazide, many specialists believed chlorthalidone would be more beneficial in reducing the risks of developing heart disease.

How Was This Study Conducted?

According to NewMediaWire, “Researchers recruited more than 13,500 U.S. veterans who were at least 65 years old and received care from 4,120 primary care professionals at 500 clinics. Participants were predominantly men (97%), white veterans (77%), and non-Hispanic veterans (93%), with 55% living in urban areas. At the beginning of the study, the average systolic blood pressure (the top number in a blood pressure reading) was 139 mm Hg. The participants were randomized into one of two groups 1) hydrochlorothiazide at 25 or 50 mg/day, or 2) an equivalent dose of 12.5 or 25 mg/day of chlorthalidone. The study examined rates of heart attack, stroke, heart failure, or non-cancer death after a median of about 2.5 years.

The Results:

The analysis of all study participants found:

• The heart disease and death rates for the chlorthalidone group (9.4%) and the hydrochlorothiazide group (9.3%) were nearly identical;
• There was also no difference in secondary outcomes (heart attack, stroke, heart failure, or other cardiovascular outcomes) between the participants taking the two different medications.
• However, in a subgroup analysis, differences were found:
  • Among the participants who had a history of heart attack or stroke, those taking chlorthalidone had reduced the risks of heart disease and death by an average of 27%;
  • Chlorthalidone tended to worsen these outcomes by an average of 12% in participants who did not have a history of heart attack or stroke.

‘We were surprised by these results,’ Dr. Ishani said (Areef Ishani, M.D., the study’s corresponding author, is also the director of the Minneapolis Primary Care and Specialty Care Integrated Care Community and the director of the VA Midwest Health Care Network in Minneapolis). ‘We expected chlorthalidone to be more effective overall, however, learning about these differences in patients who have a history of cardiovascular disease may affect patient care. It’s best for people to talk with their healthcare clinicians about which of these medications is better for their individual needs.

‘More research is needed to explore these results further because we don’t know how they may fit into treating the general population.’

“The authors also note there was a slight statistical difference among participants who had low potassium levels, which is a risk for irregular heart rhythm, in the chlorthalidone (6%) group vs. the hydrochlorothiazide group (4.4%). There was also a tendency for more people with low potassium to be hospitalized in the chlorthalidone group (1.5%) compared to the hydrochlorothiazide group (1.1%). More research is needed to determine if these results are true differences or if they were caused by the way participants were recruited. In addition, how this applies to women or other populations is unclear.”

More Information Is Needed

As Dr. Ishani stated, there is more work to be done, but clearly, this is an area of interest, and moving forward it would be wise for further studies to be completed. This is NOT a call for folks to stop taking medications, but it is and should be, a point of interest to both Doctors and patients, alike.

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As always, this blog is not a replacement for sound medical advice. I am not a doctor. Please make an appointment to see your healthcare provider and put a good plan in place that works for you and the needs of your body.

That’s all I have for you this week, dear reader. I’ll see you back here next Wednesday to share another cup of coffee. Until then, be good to yourself and each other.

Mind, Body, Spirit…Osteopathic Doctors treat the whole person, not just the ailment. Is your PCP a DO? Would you like to learn more about Osteopathic Physicians? Click HERE!