HCTZ a “Paltry” Antihypertensive, With No Effect on Outcomes, New Analysis Suggests
June 16, 2009 (Milan, Italy) – Hydrochlorothiazide (HCTZ), the most commonly employed blood-pressure-lowering drug in the US, used at the usual doses prescribed–12.5 mg to 25 mg/per day–is a “paltry” antihypertensive, inferior to all other drug classes, and there is no published evidence that it reduces heart attack or stroke . These are the controversial conclusions of a new pooled analysis of trials reported by Dr Franz Messerli (St Luke’s-Roosevelt Hospital, New York, NY) during a late-breaking clinical-trial session here at the European Meeting on Hypertension 2009 this weekend.
Messerli stressed that his conclusions relate to 24-hour ambulatory BP monitoring and that, “when it comes to office BP, HCTZ isn’t that bad. In the clinic, BP [with HCTZ] looks fairly decent, it’s almost as good as other antihypertensive drugs, which means very simply that HCTZ lowers the BP fairly well during the day, when the patient sees the doctor in the office, but at night and early-morning hours, it loses its antihypertensive efficacy, so it creates a false sense of security for the patient and the doctor alike.
“In a nutshell, HCTZ has lousy antihypertensive efficacy, there are no outcomes data for it, and it should not be used as initial therapy,” Messerli told heartwire . He added that since conducting this analysis, he has pretty much ceased to use HCTZ. “I used it extensively before this analysis, absolutely. I personally use much more chlorthalidone now, for which we have good, solid outcomes data. But unfortunately there are numerous fixed-dose combinations with HCTZ available at the current time, so you cannot escape the use of it completely.” And Messerli says he fears the new US Joint National Committee (JNC) guidelines on hypertension, due to be updated later this year (JNC 8), will continue to recommend use of thiazide diuretics as first-line therapy, “and they are fully aware that thiazides translate–at least to the American physicians–as HCTZ and nothing else.”
fonte: Medscapes Pharmacist