Highlights of the research:
In a research evaluating the effectiveness of two high blood pressure medication (two diuretics) amongst aged veterans, there was no difference in cardiovascular outcomes or non-cancer deaths.
There was additionally no difference in coronary heart assault, stroke, coronary heart failure or different cardiovascular outcomes.
In a small subgroup (10%) of individuals with a historical past of coronary heart assault or stroke, therapy with chlorthalidone decreased the variety of deaths from coronary heart assault, stroke, and coronary heart failure by 27%. However, individuals with high blood pressure who didn’t have a coronary heart assault or stroke had a 12% elevated danger of heart problems when taking chlorthalidone. The researchers mentioned it was unclear how to interpret the outcomes of this subgroup in the context of the general trial, which discovered no difference between the two medication.
Embargoed 9:46 a.m. CT/10:46 a.m. ET, Fri. November 5, 2022
(NewMediaWire) – November 05, 2022 – Two frequent diuretics used to management blood pressure have no difference in cardiovascular occasions, together with loss of life, in accordance to current analysis offered at present at the American Heart Association’s 2022 Scientific Sessions in CHICAGO. doesn’t. personally in Chicago and in follow, in November. 5-7, 2022 is the first international change of the newest scientific advances, analysis and evidence-based scientific follow updates in cardiovascular science.
Among greater than 13,500 research members, these handled with the blood pressure-lowering drug chlorthalidone had no difference in cardiovascular outcomes or most cancers deaths in contrast with these handled with hydrochlorothiazide. However, amongst a subgroup with a historical past of coronary heart assault or stroke, these taking chlorthalidone had a mean 27% decrease danger of coronary heart illness and loss of life.
The outcomes are from a research that examined whether or not chlorthalidone was superior to hydrochlorothiazide in stopping heart problems in individuals with high blood pressure. According to the American Heart Association’s Heart Disease and Stroke Statistics 2022 Update, practically half of U.S. adults have high blood pressure, the main reason for coronary heart illness. Chlorthalidone and hydrochlorothiazide are diuretics which were prescribed for greater than 50 years and are first-line remedies for high blood pressure. Based on earlier research and different research that chlorthalidone higher managed blood pressure over 24 hours than hydrochlorothiazide, many specialists believed that chlorthalidone was extra helpful in lowering the danger of coronary heart illness.
The researchers designed the Diuretic Comparison Project (DCP) as a scientific trial that permits members and healthcare professionals to know which medication are being prescribed and to administer the medication in real-world settings. The checkpoint supplied a number of distinctive options of the trial, defined Aref Ishani, MD, research writer, director of the Minneapolis Society of Primary Care and Specialty Care, and director of the VA Midwest Health Care Network. Minneapolis.
“Patients can proceed their regular care with their regular care workforce as we’ve launched this trial to major care clinics,” Ishani mentioned. “We used the members’ digital well being report to observe outcomes. This research was non-intrusive, cost-effective and cheap. In addition, we were ready to recruit nearly half of the members from a really rural inhabitants, which isn’t typical for us for the sort of research. Usually, giant educational should depend on medical facilities.”
Researchers recruited 13,500 US veterans aged 65 and over who were cared for by 4,120 major care professionals at 500 clinics. Participants were predominantly male (97%), white veterans (77%), non-Hispanic veterans (93%), and 55% lived in city areas. At the starting of the research, the imply systolic blood pressure (the highest studying on the blood pressure studying) was 139 mm Hg. Participants were randomized to certainly one of two teams: 1) hydrochlorothiazide 25 or 50 mg/day or 2) an equal dose of chlorthalidone 12.5 or 25 mg/day. The research checked out charges of coronary heart assault, stroke, coronary heart failure or non-cancer loss of life over a mean of two.5 years.
Analysis of all research members revealed the following:
Heart illness and loss of life charges were nearly similar for the chlorthalidone group (9.4%) and the hydrochlorothiazide group (9.3%);
There was no difference in secondary outcomes (coronary heart assault, stroke, coronary heart failure or different cardiovascular outcomes) between members taking the two totally different medication.
However, subgroup evaluation discovered variations:
Among members with a historical past of coronary heart assault or stroke, these taking chlorthalidone decreased their danger of coronary heart illness and loss of life by a mean of 27%;
Chlorthalidone worsened these outcomes by a mean of 12% in members with out a historical past of coronary heart assault or stroke.
“We were shocked by these outcomes,” Ishani mentioned. “We anticipated that chlorthalidone could be more practical general, however understanding about these variations in sufferers with heart problems might have an effect on affected person care. It is greatest for individuals to speak with their healthcare suppliers about which of those medication is greatest for his or her particular person wants.”
“More analysis is required to additional examine these outcomes, as we do not know the way they apply to therapy in the normal inhabitants.”
The authors additionally observe that there was little statistical difference between members with low potassium ranges, which is prone to coronary heart rhythm disturbances, versus the chlorthalidone group (6%). hydrochlorothiazide group (4.4%). There was additionally a pattern towards extra hospitalizations for hypokalemia in the chlorthalidone (1.5%) group in contrast with the hydrochlorothiazide group (1.1%). More analysis is required to decide whether or not these outcomes are true variations or whether or not they’re due to the manner members were recruited. Furthermore, it’s unclear how this is applicable to girls or different populations.
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 Howe, MPH; Alison Clint, 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 offered in the summary.
The research was funded by the VA Cooperative Studies Program.
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