HealthDay News — Compared with placebo, chlorthalidone therapy improves blood pressure control at 12 weeks among patients with advanced chronic kidney disease and poorly controlled hypertension, according to a study published online Nov. 5 in the New England Journal of Medicine. The research was published to coincide with Kidney Week, the annual meeting of the American Society of Nephrology, held virtually from Nov. 4 to 7.
Rajiv Agarwal, M.D., from the Indiana University School of Medicine in Indianapolis, and colleagues randomly assigned 160 patients with stage 4 chronic kidney disease and poorly controlled hypertension in a 1:1 ratio to receive chlorthalidone at an initial dose of 12.5 mg/day, with increases every four weeks up to a maximum of 50 mg/day if needed, or placebo. Overall, 76 percent of the patients had diabetes mellitus and 60 percent were receiving loop diuretics.
At baseline, patients were prescribed a mean of 3.4 ± 1.4 antihypertensive medications. The researchers found that from baseline to 12 weeks, the adjusted change in 24-hour systolic blood pressure was −11.0 mm Hg and −0.5 mm Hg in the chlorthalidone and placebo groups, respectively. From baseline to 12 weeks, the percent change in the urinary albumin-to-creatinine ratio was 50 percentage points lower in the chlorthalidone group versus the placebo group. Compared with the placebo group, the chlorthalidone group more often had hypokalemia, reversible increases in serum creatinine level, hyperglycemia, dizziness, and hyperuricemia.
“The time course of the blood-pressure changes suggests that most of the reduction in blood pressure occurred within four weeks after therapy with 12.5 mg of chlorthalidone was initiated,” the authors write.
Several authors disclosed financial ties to the biopharmaceutical industry.