Document Detail


Long-term effects of chlorthalidone versus hydrochlorothiazide on electrocardiographic left ventricular hypertrophy in the multiple risk factor intervention trial.
MedLine Citation:
PMID:  22025372     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Chlorthalidone (CTD) reduces 24-hour blood pressure more effectively than hydrochlorothiazide (HCTZ), but whether this influences electrocardiographic left ventricular hypertrophy is uncertain. One source of comparative data is the Multiple Risk Factor Intervention Trial, which randomly assigned 8012 hypertensive men to special intervention (SI) or usual care. SI participants could use CTD or HCTZ initially; previous analyses have grouped clinics by their main diuretic used (C-clinics: CTD; H-clinics: HCTZ). After 48 months, SI participants receiving HCTZ were recommended to switch to CTD, in part because higher mortality was observed for SI compared with usual care participants in H-clinics, whereas the opposite was found in C-clinics. In this analysis, we examined change in continuous measures of electrocardiographic left ventricular hypertrophy using both an ecological analysis by previously reported C- or H-clinic groupings and an individual participant analysis where use of CTD or HCTZ by SI participants was considered and updated annually. Through 48 months, differences between SI and usual care in left ventricular hypertrophy were larger for C-clinics compared with H-clinics (Sokolow-Lyon: -93.9 versus -54.9 μV, P=0.049; Cornell voltage: -68.1 versus -35.9 μV, P=0.019; Cornell voltage product: -4.6 versus -2.2 μV/ms, P=0.071; left ventricular mass: -4.4 versus -2.8 g, P=0.002). At the individual participant level, Sokolow-Lyon and left ventricular mass were significantly lower for SI men receiving CTD compared with HCTZ through 48 months and 84 months of follow-up. Our findings on left ventricular hypertrophy support the idea that greater blood pressure reduction with CTD than HCTZ may have led to differences in mortality observed in the Multiple Risk Factor Intervention Trial.
Authors:
Michael E Ernst; James D Neaton; Richard H Grimm; Gary Collins; William Thomas; Elsayed Z Soliman; Ronald J Prineas;
Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural     Date:  2011-10-24
Journal Detail:
Title:  Hypertension     Volume:  58     ISSN:  1524-4563     ISO Abbreviation:  Hypertension     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-11-18     Completed Date:  2012-01-03     Revised Date:  2014-03-20    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1001-7     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Adult
Antihypertensive Agents / therapeutic use*
Blood Pressure / drug effects
Chlorthalidone / therapeutic use*
Combined Modality Therapy
Diuretics / therapeutic use*
Electrocardiography / drug effects*
Follow-Up Studies
Humans
Hydrochlorothiazide / therapeutic use*
Hypertension / drug therapy*,  therapy
Hypertrophy, Left Ventricular / epidemiology,  etiology,  physiopathology,  prevention & control*
Male
Middle Aged
Risk Factors
Treatment Outcome
Grant Support
ID/Acronym/Agency:
R01 HL068140/HL/NHLBI NIH HHS; R01 HL068140-01/HL/NHLBI NIH HHS; R01-HL68140/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Antihypertensive Agents; 0/Diuretics; 0J48LPH2TH/Hydrochlorothiazide; Q0MQD1073Q/Chlorthalidone
Comments/Corrections
Comment In:
Hypertension. 2011 Dec;58(6):994-5   [PMID:  22025371 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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