Chlorthalidone therapy improved blood pressure control at 12 weeks compared with placebo in patients with advanced chronic kidney disease and poorly controlled hypertension.

Study results

Patients with stage 4 chronic kidney disease and poorly controlled hypertension, were randomly assigned in 1:1 ratio to receive chlorthalidone at an initial dose of 12.5 mg per day, with increases every 4 weeks if needed to a maximum dose of 50 mg per day.

At randomization, the mean 24-hour ambulatory systolic blood pressure was 142.6±8.1 mmHg in the chlorthalidone group and 140.1±8.1 mmHg in the placebo group.

The adjusted change in 24-hour systolic blood pressure from baseline to 12 weeks was -11.0 mmHg (95% confidence interval [CI], -3.9 to -8.1) in the chlorthalidone group and -0.5 mm Hg (95% CI, -3.5 to 2.5) in the placebo group. 

Hypokalemia, reversible increases in serum creatinine level, hyperglycemia, dizziness, and hyperuricemia occur more frequently in the chlorthalidone group than in the placebo group. 

Reference: Agarwal R, Sinha AD, Cramer AE, et al. Chlorthalidone for hypertension in advanced chronic kidney disease. N Engl J Med. 2021; 385: 2507-2519.