Call to Downgrade Hydrochlorothiazide as Gold Standard Therapy
I recommend that you read the entire article (only 3 paragraphs.) I am now moving towards using chlorthalidone in any difficult to control hypertension patient.
Chorthalidone rather than hydrocholorthiazide
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{ 3 comments… read them below or add one }
I used to use a lot of chlorthalidone 25 years ago and saw an awful lot of significant hypokalemia. As a single agent, it is probably more effective than HCTZ, but you have to monitor electrolytes regularly and frequently add a potassium supplement. I think a better strategy is to start with an ACE or ARB, add HCTZ as an “enhancer”, and then add a calcium channel blocker or beta blocker if more control is needed.
Ever since ALLHAT I have switched to chlorthalidone. I am not certain there is a big difference… but, I feel there may be some benefit over HCTZ… and at least there is a nice big study for the evidence based medicine fans (albeit there are significant problems with ALLHAT)
i started doing this 6 months ago and have had quite an impressive improvment in my difficult Bp pts.