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Importance: Hypertension is a risk factor for the development and progression of chronic kidney disease (CKD). It is unclear whether different thiazide diuretics have a differential impact on kidney outcomes.

Objective: To compare kidney outcomes in patients with hypertension taking chlorthalidone and hydrochlorothiazide.

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Purpose of the study was to enhance the solubility of chlorthalidone, poorly soluble diuretic that has been the used for lowering high blood pressure for the past half-century. Solubility is a challenge for approximately 90% of drug candidates. Chlorthalidone is BCS Class IV drug whose poor solubility needs to be improved in order to optimize its efficacy.

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Characteristics of VA hospitals by participation status in a large pragmatic embedded clinical trial.

Contemp Clin Trials

January 2025

Cooperative Studies Program Coordinating Center, VA Boston Healthcare System, Boston, MA, USA; Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA. Electronic address:

Article Synopsis
  • The Diuretic Comparison Project (DCP) was a pragmatic trial in the VA healthcare system that compared two diuretics, chlorthalidone and hydrochlorothiazide, to see which better prevents major cardiovascular events in hypertensive patients.
  • The study analyzed data from participating and non-participating medical centers to determine factors influencing their decision to join, including socio-economic status and hospital performance metrics.
  • Findings revealed that urban centers, those with higher incomes, and hospitals with prior research experience were more likely to participate, suggesting that improving engagement with lesser-involved facilities could enhance future recruitment for clinical trials.*
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Background: The variance between guideline recommendations and real-world usage might stem from the perception that chlorthalidone poses a higher risk of adverse effects, although there is no clear evidence of disparities in cardiovascular outcomes. It is crucial to assess both the clinical cardiovascular effects and adverse reactions of both drugs for clinical guidance. In this study, we present a comprehensive and updated analysis comparing the efficacy and safety of chlorthalidone (CHLOR) versus hydrochlorothiazide (HCTZ) for the prevention of cardiovascular diseases through lower the blood pressure.

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[The delapril-indapamide combination in treatment of arterial hypertension: practical implications in light of the new guidelines.].

Recenti Prog Med

October 2024

Dipartimento di Cardiologia, Ospedale Santa Maria della Misericordia, Perugia.

The recent guidelines issued by the European Society of Hypertension reaffirmed that the degree of control of hypertension remains suboptimal worldwide. In order to increase the proportion of well-controlled patients, in addition to nonpharmacological measures, it is necessary to improve the implementation of drug therapy in the clinical practice as much as possible. Initial therapy should almost always be based on the combination, free or fixed, between ACE inhibitor drugs, or direct angiotensin II inhibitors ('sartans') and diuretics (thiazide or thiazide-like) or calcium channel blockers at the maximum recommended and well-tolerated dose.

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