{"id":2242,"date":"2021-09-15T00:00:00","date_gmt":"2021-09-15T04:00:00","guid":{"rendered":"https:\/\/icesontario.wpengine.com\/journal-articles\/comparison-of-clinical-outcomes-and-safety-associated-with-chlorthalidone-vs-hydrochlorothiazide-in-older-adults-with-varying-levels-of-kidney-function\/"},"modified":"2023-06-14T20:04:15","modified_gmt":"2023-06-15T00:04:15","slug":"comparison-of-clinical-outcomes-and-safety-associated-with-chlorthalidone-vs-hydrochlorothiazide-in-older-adults-with-varying-levels-of-kidney-function","status":"publish","type":"journal_article","link":"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/comparison-of-clinical-outcomes-and-safety-associated-with-chlorthalidone-vs-hydrochlorothiazide-in-older-adults-with-varying-levels-of-kidney-function\/","title":{"rendered":"Comparison of clinical outcomes and safety associated with chlorthalidone vs hydrochlorothiazide in older adults with varying levels of kidney function"},"content":{"rendered":"<p><strong>Importance <\/strong>&#x2014; Thiazide diuretics are commonly prescribed for the treatment of hypertension, a disease highly prevalent among older individuals and in those with chronic kidney disease. How specific thiazide diuretics compare in regard to safety and clinical outcomes in these populations remains unknown.<\/p>\n<p><strong>Objective <\/strong>&#x2014; To compare safety and clinical outcomes associated with chlorthalidone or hydrochlorothiazide use among older adults with varying levels of kidney function.<\/p>\n<p><span class=\"bold\">Design, Setting, and Participants<\/span> &#x2014; This population-based retrospective cohort study was conducted in Ontario, Canada, from 2007 to 2015. Participants included adults aged 66 years or older who initiated chlorthalidone or hydrochlorothiazide during this period. Data were analyzed from December 2019 through September 2020.<\/p>\n<p><strong>Exposures <\/strong>&#x2014; New chlorthalidone users were matched 1:4 with new hydrochlorothiazide users by a high-dimensional propensity score. Time-to-event models accounting for competing risks examined the associations between chlorthalidone vs hydrochlorothiazide use and the outcomes of interest overall and within estimated glomerular filtration rate (eGFR) categories (&#x2265;60, 45-59, and &lt;45 mL\/min\/1.73 m<sup>2<\/sup>).<\/p>\n<p><span class=\"bold\">Main Outcomes and Measures<\/span> &#x2014; The outcomes of interest were adverse kidney events (ie, eGFR decline &#x2265;30%, dialysis, or kidney transplantation), cardiovascular events (composite of myocardial infarction, coronary revascularization, heart failure, or atrial fibrillation), all-cause mortality, and electrolyte anomalies (ie, sodium or potassium levels outside reference ranges).<\/p>\n<p><strong>Results <\/strong>&#x2014; After propensity score matching, the study cohort included 12 722 adults (mean [SD] age, 74 [7] years; 7063 [56%] women; 5659 [44%] men; mean [SD] eGFR, 69 [19] mL\/min\/1.73 m<sup>2<\/sup>), including 2936 who received chlorthalidone and 9786 who received hydrochlorothiazide. Chlorthalidone use was associated with a higher risk of eGFR decline of 30% or greater (hazard ratio [HR], 1.24 [95% CI, 1.13-1.36]) and cardiovascular events (HR, 1.12 [95% CI, 1.04-1.22]) across all eGFR categories compared with hydrochlorothiazide use. Chlorthalidone use was also associated with a higher risk of hypokalemia compared with hydrochlorothiazide use, which was more pronounced among those with higher eGFR (eGFR &#x2265;60 mL\/min\/1.73 m2: HR, 1.86 [95% CI, 1.67-2.08]; eGFR 45-59 mL\/min\/1.73 m<sup>2<\/sup>: HR, 1.57 [95% CI, 1.25-1.96]; eGFR &lt;45 mL\/min\/1.73 m<sup>2<\/sup>: HR, 1.10 [95% CI, 0.84-1.45]; <em>P<\/em> for interaction = .001). No significant differences were observed between chlorthalidone and hydrochlorothiazide for dialysis or kidney transplantation (HR, 1.44 [95% CI, 0.88-2.36]), all-cause mortality (HR, 1.10 [95% CI, 0.93-1.29]), hyperkalemia (HR, 1.05 [95% CI, 0.79-1.39]), or hyponatremia (HR, 1.14 [95% CI, CI 0.98-1.32]).<\/p>\n<p><span class=\"bold\">Conclusions and Relevance <\/span>&#x2014; This cohort study found that among older adults, chlorthalidone use was associated with a higher risk of eGFR decline, cardiovascular events, and hypokalemia compared with hydrochlorothiazide use. The excess risk of hypokalemia with chlorthalidone was attenuated in participants with reduced kidney function. Placed in context with prior observational studies comparing the safety and clinical outcomes associated with thiazide diuretics, these results suggest that there is no evidence to prefer chlorthalidone over hydrochlorothiazide.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Importance &#x2014; Thiazide diuretics are commonly prescribed for the treatment of hypertension, a disease highly prevalent among older individuals and in those with chronic kidney disease. How specific thiazide diuretics compare in regard to safety and clinical outcomes in these populations remains unknown. Objective &#x2014; To compare safety and clinical outcomes associated with chlorthalidone or [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[],"migration-helper-qa-sample-set":[],"class_list":["post-2242","journal_article","type-journal_article","status-publish","hentry"],"acf":{"citation":"Edwards C, Hundemer GL, Petrcich W, Canney M, Knoll G, Burns K, Bugeja A, Sood MM. <em>JAMA Netw Open<\/em>. 2021; 4(9):e2123365. Epub 2021 Sep 15.","source_url":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2784119","ices_scientist":[1264,20606],"site":[6734],"research_program":[6743],"news_release":[],"journal_article":[],"atlas":[],"research_report":[],"infographic":[],"video":[],"downloads":null,"links":null,"sitecore_item_id":"4A9882E4-A424-42A5-A069-D1C0C364A7EF","sitecore_item_name":"Comparison-of-clinical-outcomes-and-safety-associated-with-chlorthalidone-vs-hydrochlorothiazide","sitecore_field_values":"{\n  \"Title\": \"Comparison of clinical outcomes and safety associated with chlorthalidone vs hydrochlorothiazide in older adults with varying levels of kidney function\",\n  \"Short title\": \"Comparison of clinical outcomes and\",\n  \"Summary\": \"The objective of this study was to compare safety and clinical outcomes associated with chlorthalidone or hydrochlorothiazide use among older adults with varying levels of kidney function.\",\n  \"Citation\": \"<p>Edwards C, Hundemer GL, Petrcich W, Canney M, Knoll G, Burns K, Bugeja A, Sood MM. <em>JAMA Netw Open<\/em>. 2021; 4(9):e2123365. Epub 2021 Sep 15. DOI: <a href=\"https:\/\/doi.org\/10.1001\/jamanetworkopen.2021.23365\" title=\"opens external link\">https:\/\/doi.org\/10.1001\/jamanetworkopen.2021.23365<\/a><\/p>\",\n  \"Abstract\": \"<p><strong>Importance <\/strong>&mdash; Thiazide diuretics are commonly prescribed for the treatment of hypertension, a disease highly prevalent among older individuals and in those with chronic kidney disease. How specific thiazide diuretics compare in regard to safety and clinical outcomes in these populations remains unknown.<\/p>n<p><strong>Objective <\/strong>&mdash; To compare safety and clinical outcomes associated with chlorthalidone or hydrochlorothiazide use among older adults with varying levels of kidney function.<\/p>n<p><span class=\"bold\">Design, Setting, and Participants<\/span> &mdash; This population-based retrospective cohort study was conducted in Ontario, Canada, from 2007 to 2015. Participants included adults aged 66 years or older who initiated chlorthalidone or hydrochlorothiazide during this period. Data were analyzed from December 2019 through September 2020.<\/p>n<p><strong>Exposures <\/strong>&mdash; New chlorthalidone users were matched 1:4 with new hydrochlorothiazide users by a high-dimensional propensity score. Time-to-event models accounting for competing risks examined the associations between chlorthalidone vs hydrochlorothiazide use and the outcomes of interest overall and within estimated glomerular filtration rate (eGFR) categories (&ge;60, 45-59, and &lt;45 mL\/min\/1.73 m<sup>2<\/sup>).<\/p>n<p><span class=\"bold\">Main Outcomes and Measures<\/span> &mdash; The outcomes of interest were adverse kidney events (ie, eGFR decline &ge;30%, dialysis, or kidney transplantation), cardiovascular events (composite of myocardial infarction, coronary revascularization, heart failure, or atrial fibrillation), all-cause mortality, and electrolyte anomalies (ie, sodium or potassium levels outside reference ranges).<\/p>n<p><strong>Results <\/strong>&mdash; After propensity score matching, the study cohort included 12 722 adults (mean [SD] age, 74 [7] years; 7063 [56%] women; 5659 [44%] men; mean [SD] eGFR, 69 [19] mL\/min\/1.73 m<sup>2<\/sup>), including 2936 who received chlorthalidone and 9786 who received hydrochlorothiazide. Chlorthalidone use was associated with a higher risk of eGFR decline of 30% or greater (hazard ratio [HR], 1.24 [95% CI, 1.13-1.36]) and cardiovascular events (HR, 1.12 [95% CI, 1.04-1.22]) across all eGFR categories compared with hydrochlorothiazide use. Chlorthalidone use was also associated with a higher risk of hypokalemia compared with hydrochlorothiazide use, which was more pronounced among those with higher eGFR (eGFR &ge;60 mL\/min\/1.73 m2: HR, 1.86 [95% CI, 1.67-2.08]; eGFR 45-59 mL\/min\/1.73 m<sup>2<\/sup>: HR, 1.57 [95% CI, 1.25-1.96]; eGFR &lt;45 mL\/min\/1.73 m<sup>2<\/sup>: HR, 1.10 [95% CI, 0.84-1.45]; <em>P<\/em> for interaction = .001). No significant differences were observed between chlorthalidone and hydrochlorothiazide for dialysis or kidney transplantation (HR, 1.44 [95% CI, 0.88-2.36]), all-cause mortality (HR, 1.10 [95% CI, 0.93-1.29]), hyperkalemia (HR, 1.05 [95% CI, 0.79-1.39]), or hyponatremia (HR, 1.14 [95% CI, CI 0.98-1.32]).<\/p>n<p><span class=\"bold\">Conclusions and Relevance <\/span>&mdash; This cohort study found that among older adults, chlorthalidone use was associated with a higher risk of eGFR decline, cardiovascular events, and hypokalemia compared with hydrochlorothiazide use. The excess risk of hypokalemia with chlorthalidone was attenuated in participants with reduced kidney function. Placed in context with prior observational studies comparing the safety and clinical outcomes associated with thiazide diuretics, these results suggest that there is no evidence to prefer chlorthalidone over hydrochlorothiazide.<\/p>n<p><a href=\"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2784119\" title=\"Opens external link\">View full text<\/a><\/p>\",\n  \"Research Programs\": \"{92CC48EB-79AA-49F6-8A80-16D185170261}\",\n  \"ICES Locations\": \"{0AD77E2C-C883-4E93-8B9A-40B82D50E3A5}\",\n  \"ICES Scientists\": \"{7091E417-B1CA-4B4D-9626-E4A32E614F5E}|{F73EDA66-8516-43CD-9A4F-809680DF6D68}\",\n  \"Posted Date\": \"20210915T000000\",\n  \"Show on Publications Landing Page\": \"1\"\n}","previous_url":"https:\/\/www.ices.on.ca\/Publications\/Journal-Articles\/2021\/September\/Comparison-of-clinical-outcomes-and-safety-associated-with-chlorthalidone-vs-hydrochlorothiazide"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Comparison of clinical outcomes and safety associated with chlorthalidone vs hydrochlorothiazide in older adults with varying levels of kidney function<\/title>\n<meta name=\"description\" content=\"Importance &#x2014; Thiazide diuretics are commonly prescribed for the treatment of hypertension, a disease highly prevalent among older individuals and\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/comparison-of-clinical-outcomes-and-safety-associated-with-chlorthalidone-vs-hydrochlorothiazide-in-older-adults-with-varying-levels-of-kidney-function\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"ICES | Comparison of clinical outcomes and safety associated with chlorthalidone vs hydrochlorothiazide in older adults with varying levels of kidney function\" \/>\n<meta property=\"og:description\" content=\"Importance &#x2014; Thiazide diuretics are commonly prescribed for the treatment of hypertension, a disease highly prevalent among older individuals and\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.ices.on.ca\/fr\/publications\/journal-articles\/comparison-of-clinical-outcomes-and-safety-associated-with-chlorthalidone-vs-hydrochlorothiazide-in-older-adults-with-varying-levels-of-kidney-function\/\" \/>\n<meta property=\"og:site_name\" content=\"ICES\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/ICESOntario\/\" \/>\n<meta property=\"article:modified_time\" content=\"2023-06-15T00:04:15+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.ices.on.ca\/wp-content\/uploads\/2024\/11\/ic-es-data-discovery-better-health-logo.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"675\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/publications\\\/journal-articles\\\/comparison-of-clinical-outcomes-and-safety-associated-with-chlorthalidone-vs-hydrochlorothiazide-in-older-adults-with-varying-levels-of-kidney-function\\\/\",\"url\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/publications\\\/journal-articles\\\/comparison-of-clinical-outcomes-and-safety-associated-with-chlorthalidone-vs-hydrochlorothiazide-in-older-adults-with-varying-levels-of-kidney-function\\\/\",\"name\":\"ICES | Comparison of clinical outcomes and safety associated with chlorthalidone vs hydrochlorothiazide in older adults with varying levels of kidney function\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.ices.on.ca\\\/fr\\\/#website\"},\"datePublished\":\"2021-09-15T04:00:00+00:00\",\"dateModified\":\"2023-06-15T00:04:15+00:00\",\"description\":\"Importance &#x2014; 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