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Evidence-based diuretics: focus on chlorthalidone and indapamide

    James J DiNicolantonio

    *Author for correspondence:

    E-mail Address: jjdinicol@gmail.com

    Mid America Heart Institute at Saint Luke's Hospital, Kansas City, MO, USA

    ,
    Jaikrit Bhutani

    Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India

    ,
    Carl J Lavie

    John Ochsner Heart & Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA

    Pennington Biomedical Research Center, Baton Rouge, LA, USA

    &
    James H O'Keefe

    Mid America Heart Institute at Saint Luke's Hospital, Kansas City, MO, USA

    Published Online:https://doi.org/10.2217/fca.14.83

    ABSTRACT 

    Thiazide and thiazide-like diuretics are cornerstone treatments for hypertension. However, unlike chlorthalidone (CTD) and indapamide (IDP), hydrochlorothiazide (HCTZ) lacks evidence for reducing morbidity and mortality as monotherapy compared with placebo or control. Despite this fact, HCTZ is prescribed much more frequently than CTD or IDP. We believe that all hypertension guidelines should follow the National Institute for Health and Excellence (NICE) and make IDP and CTD first choice ‘thiazide-like diuretics.’ This article will focus on the available evidence pertaining to HCTZ versus CTD and IDP. We will review the pharmacological differences between these three diuretics, as well as the clinical trial data and important side effects.

    Papers of special note have been highlighted as: • of interest

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