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To the Editor: In the Antihypertensive and Lipid Lowering to Prevent Heart Attack Trial,¹ the first-line therapy in the low-dose diuretic arm was chlorthalidone. Some recent trials of low-dose diuretics, however, have used other treatments such as indapamide and hydrochlorothiazide, sometimes in combination with triamterene or amiloride.^2-3 Although chlorthalidone is about 1.5 to 2.0 times more potent and has a much longer duration of action than hydrocholorthiazide,⁴ it remains unknown whether different diuretics are associated with different clinical outcomes.

Methods

Using data from our network meta-analysis,⁵ we divided placebo-controlled trials of low-dose diuretics into those that used chlorthalidone (n = 2)^6-8 and those that used other low-dose diuretic therapies (n = 3)^2-3,9 (Table 1). We used fixed-effects techniques for the comparison of 6 clinical outcomes, including coronary heart disease (CHD) events, heart failure, stroke, cardiovascular disease (CVD) events, CVD mortality, and total mortality. We first computed the relative risk . . . [Full Text of this Article]

Bruce M. Psaty, MD, PhD
psaty@u.washington.edu

Thomas Lumley, PhD
Cardiovascular Health Research Unit
University of Washington
Seattle

Curt D. Furberg, MD, PhD
Department of Public Health Sciences
Wake Forest University
Winston-Salem, NC

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