No difference in cardiac outcomes found when using two diuretics to treat blood pressure

Research Highlights:

  • In a study comparing the effectiveness of two blood pressure medications (both diuretics) in older veterans, there was no difference in cardiovascular outcomes or non-cancer deaths.

  • There was also no difference in heart attacks, strokes, heart failure or other cardiovascular outcomes.

  • In a small subgroup (10%) of people with a history of heart attack or stroke, there was a 27% reduction in deaths from heart attack, stroke and heart failure when they been treated with chlorthalidone. Yet people with high blood pressure who had not had a heart attack or stroke tended to have a 12% increased risk of developing cardiovascular disease when taking chlorthalidone. It’s unclear how to interpret this subgroup result in the context of the overall trial showing no difference between the two drugs, the researchers said.

Embargoed until 9:46 a.m. CT / 10:46 a.m. ET, Sat, November 5, 2022

(NewMediaWire) – November 05, 2022 – CHICAGO Two common diuretics used to control blood pressure had no difference in cardiovascular outcomes, including death, according to late-breaking scientific research presented today at the 2022 Scientific Sessions of the ‘American Heart Association. The meeting, held in-person in Chicago and virtually, November 5-7, 2022, is a premier global exchange on the latest scientific advances, research and evidence-based clinical practice updates. in cardiovascular science.

Among more than 13,500 study participants, those treated with the blood pressure medication chlorthalidone appeared to have no difference in cardiovascular outcomes or non-cancer deaths compared to those treated with hydrochlorothiazide. Yet among the small group who had a history of heart attack or stroke, those taking chlorthalidone reduced the risk of heart disease and death by an average of 27%.

The results come from a study to find out if chlorthalidone was superior to hydrochlorothiazide in preventing cardiovascular events in people with high blood pressure. According to 2022 update of heart disease and stroke statistics from the American Heart Association, nearly half of American adults suffer from high blood pressure, which is a leading cause of heart disease. Chlorthalidone and hydrochlorothiazide have been prescribed diuretics for over 50 years and are considered the first-line treatment for high blood pressure. Based on previous studies and other research suggesting that chlorthalidone controlled blood pressure better over 24 hours compared to hydrochlorothiazide, many specialists believed that chlorthalidone would be more beneficial in reducing the risk of developing heart disease. .

The researchers designed the Diuretic Comparison Project (DCP) as a point-of-care clinical trial that allowed participants and healthcare professionals to find out which drug was prescribed and to administer the drug in a real-life setting. The point-of-care aspect offered several unique features to the trial, explained Areef Ishani, MD, corresponding author of the study, director of the Minneapolis Integrated Primary Care and Specialty Care Community and director of the VA Midwest Health Care Network in Minneapolis.

“Patients can continue their normal care with their usual care team because we’ve integrated this trial into primary care clinics,” Ishani said. “We tracked participants’ outcomes using their electronic health record. This study was non-intrusive, cost-effective, and inexpensive. Additionally, we were able to recruit a large rural population for almost half of the participants, and this is atypical for a study like this where we typically have to rely on large academic medical centers.”

Researchers recruited more than 13,500 US veterans age 65 and older who received care from 4,120 primary care professionals at 500 clinics. Participants were overwhelmingly male (97%), white veterans (77%), non-Hispanic veterans (93%), 55% of whom lived in urban areas. At the start of the study, the mean systolic blood pressure (the highest number in a blood pressure reading) was 139 mm Hg. Participants were randomized to 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 looked at rates of heart attack, stroke, heart failure or non-cancer death after a median of about 2.5 years.

Analysis of all study participants revealed:

  • 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 participants taking the two different drugs.

  • However, in a subgroup analysis, differences were found:

    • Among participants who had a history of heart attack or stroke, those taking chlorthalidone reduced the risk of heart disease and death by an average of 27%;

    • Chlorthalidone tended to worsen these results by an average of 12% in participants who had no history of heart attack or stroke.

“We were surprised by these results,” Ishani said. “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. Individual needs.

“Further research is needed to elucidate these findings because we don’t know how they may fit into the treatment of the general population.”

The authors also note that there was a slight statistical difference between participants who had low potassium, which is a risk of irregular heartbeat, in the chlorthalidone group (6%) compared to the hydrochlorothiazide group (4. 4%). There was also a trend for more people with low potassium to be hospitalized in the chlorthalidone group (1.5%) compared to the hydrochlorothiazide group (1.1%). Further research is needed to determine if these findings are true differences or if they were caused by the way the participants were recruited. Also, how this applies to women or other populations is unclear.

Co-authors are William C. Cushman, MD; Sarah M. Leatherman, Ph.D.; Robert A. Lew, Ph.D.; Patricia Woods, MSN, RN; Peter A. Glassman, MBBS, M.Sc.; Addison A. Taylor, MD; Cynthia Hau, MPH; Alison Klint, MS; Grant D. Huang, MPH, Ph.D., Mary T. Brophy, MD, MPH, Louis D. Fiore, MD, and Ryan E. Ferguson, Sc.D., MPH Author disclosures are listed in the abstract.

The study was funded by the VA Cooperative Studies Program.

Statements and conclusions of studies that are presented at American Heart Association scientific meetings are solely those of the study authors and do not necessarily reflect the policy or position of the Association. The Association makes no representations or warranties as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, but rather by independent review committees and are considered based on the potential to add to the diversity of scientific issues and viewpoints discussed. during a meeting. Results are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

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Additional Resources:

The American Heart Association Scientific Sessions 2022 is a leading global exchange of the latest scientific advances, research, and updates in evidence-based clinical practice in cardiovascular science. The 3-day meeting will feature more than 500 sessions focused on groundbreaking updates in basic, clinical, and population science cardiovascular sciences, Saturday through Monday November 5-7, 2022. Thousands of physicians, scientists, cardiologists , advanced practice nurses and leading allied health care professionals from around the world will come together virtually to participate in presentations, discussions and basic, clinical and population science programs that can shape the future of cardiovascular science and medicine, including prevention and quality improvement. During the three-day meeting, attendees receive exclusive access to more than 4,000 original research presentations and can earn continuing medical education (CME), continuing education (CE), or certification maintenance credits ( MOC) for training sessions. Take part in the 2022 scientific sessions on social networks via #AHA22.

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