Answering chlorthalidone person

26 May
2004

Over that past week or so, an anonymous commentor – who has a fake email address – has pestered these pages concerning ALLHAT. He/she writes:

Hello Medrants,

Please answer my question. How many +MORE+ people will have a stroke on ACE-I if you use it first line, compared to starting a thiazide diuretic ?

Well, chlorthalidone person, this sounds like a lawyer’s hypothetical question. In the two malpractice cases in which I testified (as a defense witness), the lawyer who hired me told me to carefully avoid answering hypotheticals. Thus, I cannot answer the question.

However, you cannot answer the question either. Please reread my ALLHAT rants carefully. The key to stroke prevention is BP control. BP control is not ACE or diuretic. BP control usually requires both. But you really know that, and just like irritating everyone. Or you really do not understand the ALLHAT trial.

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3 Responses to Answering chlorthalidone person

Avatar

azygos

May 26th, 2004 at 11:07 pm

I’ve gotten to the point of automatically deleting any post with no name, no email address, or a fake e-mail address.

Keeps the trolls (family members) from leaving stupid questions.

Avatar

chlorthalidone prescriber

May 29th, 2004 at 11:34 pm

OK. You start an ACE-I first. ACE-I do ++NOT++ lower bp as much as thiazides do.

You say, and I agree,
“The key to stroke prevention is BP control.”

Elevated BP causes strokes.

For the outcome of stroke: what is the Number Needed to Harm (NNH) when starting ACE-I before a thiazide.

My major point is this – a large number of patients cannot afford ACE-I. Physicians should inform patients of the pluses/minuses of starting ACE-I vs thiazide. This discussion should include COST of medications. With the extra money patients would have with the thiazides, why not prescribe the diuretic and a gym membership.

Thiazide + Gym membership is still cheaper than the ACE-I.

Not to mention, the exercise they get at the gym is the real answer to long term weight management and bp control.

Avatar

Chlorthalidone Prescriber

June 29th, 2005 at 8:04 pm

http://archinte.ama-assn.org/cgi/content/abstract/165/12/1401

Clinical Outcomes in Antihypertensive Treatment of Type 2 Diabetes, Impaired Fasting Glucose Concentration, and Normoglycemia

Results There was no significant difference in relative risk (RR) for the primary outcome in DM or NG participants assigned to amlodipine or lisinopril vs chlorthalidone or in IFG participants assigned to lisinopril vs chlorthalidone. A significantly higher RR (95% confidence interval) was noted for the primary outcome in IFG participants assigned to amlodipine vs chlorthalidone (1.73 [1.10-2.72]). Stroke was more common in NG participants assigned to lisinopril vs chlorthalidone (1.31 [1.10-1.57]). Heart failure was more common in DM and NG participants assigned to amlodipine (1.39 [1.22-1.59] and 1.30 [1.12-1.51], respectively) or lisinopril (1.15 [1.00-1.32] and 1.19 [1.02-1.39], respectively) vs chlorthalidone.

Conclusion: Our results provide no evidence of superiority for treatment with calcium channel blockers or angiotensin-converting enzyme inhibitors compared with a thiazide-type diuretic during first-step antihypertensive therapy in DM, IFG, or NG.

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