What is the use of Chlorthalidone?

From the Guidelines

Chlorthalidone is used as a first-line treatment for hypertension, particularly for its effectiveness in reducing blood pressure and cardiovascular disease events 1.

Key Points

• Chlorthalidone, a thiazide-like diuretic, is recommended as a first-line treatment for hypertension due to its efficacy in lowering blood pressure and reducing cardiovascular disease events 1.
• It is often used in combination with other antihypertensive agents, such as ACE inhibitors, ARBs, and calcium channel blockers, to achieve optimal blood pressure control 1.
• Chlorthalidone has been shown to be effective in reducing left ventricular hypertrophy (LVH), a secondary manifestation of hypertension that independently predicts future cardiovascular disease events 1.
• The use of chlorthalidone is supported by guidelines from various organizations, including the American College of Cardiology and the American Heart Association 1.
• While chlorthalidone is generally well-tolerated, it can cause hypokalemia and increase the risk of new-onset diabetes, particularly when used in combination with other diuretics or beta-blockers 1.

Clinical Considerations

• Chlorthalidone is typically initiated at a dose of 12.5-25 mg once daily and can be titrated up to 50 mg daily as needed to achieve optimal blood pressure control.
• Patients with renal impairment or those taking other medications that affect potassium levels should be monitored closely for hypokalemia when taking chlorthalidone.
• The use of chlorthalidone in patients with diabetes or those at risk for developing diabetes should be carefully considered, as it may increase the risk of new-onset diabetes.

From the FDA Drug Label

INDICATIONS & USAGE Diuretics such as chlorthalidone are indicated in the management of hypertension either as the sole therapeutic agent or to enhance the effect of other antihypertensive drugs in the more severe forms of hypertension. Chlorthalidone is indicated as adjunctive therapy in edema associated with congestive heart failure, hepatic cirrhosis, and corticosteroid and estrogen therapy Chlorthalidone has also been found useful in edema due to various forms of renal dysfunction, such as nephrotic syndrome, acute glomerulonephritis, and chronic renal failure.

The use of Chlorthalidone is for:

• Hypertension management
• Edema treatment associated with:
  • Congestive heart failure
  • Hepatic cirrhosis
  • Corticosteroid and estrogen therapy
  • Renal dysfunction, such as:
    • Nephrotic syndrome
    • Acute glomerulonephritis
    • Chronic renal failure 2

From the Research

Use of Chlorthalidone

• Chlorthalidone is used to treat hypertension, and its effectiveness and safety have been compared to hydrochlorothiazide in several studies 3, 4, 5.
• Chlorthalidone has been found to be associated with a higher risk of hypokalemia, hyponatremia, acute renal failure, chronic kidney disease, and type 2 diabetes mellitus compared to hydrochlorothiazide 3.
• However, chlorthalidone has also been found to be associated with a lower risk of diagnosed abnormal weight gain compared to hydrochlorothiazide 3.
• The mechanism by which chlorthalidone lowers blood pressure is unclear, but it may include alterations in whole body regulation and vasodilatory actions on vasculature 6.
• Chlorthalidone has also been found to have potentially beneficial, non-blood pressure related, pleiotropic effects, including improvements in endothelial function, anti-platelet activity, and oxidative status 6.

Comparison to Hydrochlorothiazide

• Several studies have compared the effectiveness and safety of chlorthalidone and hydrochlorothiazide, with some finding no significant difference in cardiovascular outcomes 3, 4.
• However, other studies have found that chlorthalidone may be more effective than hydrochlorothiazide in reducing cardiovascular events, particularly in terms of reducing left ventricular hypertrophy and congestive heart failure 6.
• The choice between chlorthalidone and hydrochlorothiazide may depend on individual patient factors, including the presence of certain comorbidities and the risk of adverse effects 7, 5.

Clinical Use

• Chlorthalidone is currently recommended as a first-line treatment for hypertension by the American College of Cardiology, although some studies have questioned this recommendation 4.
• Chlorthalidone may be particularly useful in patients with certain comorbidities, such as heart failure or left ventricular hypertrophy, due to its ability to reduce these conditions 6.
• However, chlorthalidone may not be suitable for all patients, particularly those at risk of hypokalemia or other adverse effects, and alternative treatments may be necessary 3, 5.