1
|
Pham NYT, Owen JG, Singh N, Shaffi SK. The Use of Thiazide Diuretics for the Treatment of Hypertension in Patients With Advanced Chronic Kidney Disease. Cardiol Rev 2023; 31:99-107. [PMID: 34224450 DOI: 10.1097/crd.0000000000000404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The use of thiazide diuretics for the treatment of hypertension in patients with advance chronic kidney disease. Thiazides have been recommended as the first-line for the treatment of hypertension, yet their use has been discouraged in advanced chronic kidney disease (CKD), as they are suggested to be ineffective in advanced CKD. Recent data suggest that thiazide diuretics may be beneficial blood pressure control in addition to natriuresis in existing CKD. This review discusses the commercially available thiazides with a focus on thiazide pharmacology, most common adverse effects, clinical uses of thiazide diuretic, and the evidence for efficacy of thiazide use in advanced CKD.
Collapse
Affiliation(s)
- Ngoc-Yen T Pham
- From the University of New Mexico Hospitals, Albuquerque, NM
| | - Jonathan G Owen
- University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Namita Singh
- University of New Mexico Health Sciences Center, Albuquerque, NM
| | | |
Collapse
|
2
|
Bashir KM, Burns T, Pirruccello SJ, Aurit SJ, Hilleman DE. Comparative antiplatelet effects of chlorthalidone and hydrochlorothiazide. J Clin Hypertens (Greenwich) 2022; 24:1310-1315. [PMID: 36067089 PMCID: PMC9581091 DOI: 10.1111/jch.14564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/03/2022] [Accepted: 08/06/2022] [Indexed: 11/29/2022]
Abstract
Chlorthalidone (CTD) may be superior to hydrochlorothiazide (HCTZ) in the reduction of adverse cardiovascular events in hypertensive patients. The mechanism of the potential benefit of CTD could be related to antiplatelet effects. The objective of this study was to determine if CTD or HCTZ have antiplatelet effects. This study was a prospective, double‐blind, randomized, three‐way crossover comparison evaluating the antiplatelet effects of CTD, HCTZ, and aspirin (ASA) in healthy volunteers. The effects of these treatments on platelet activation and aggregation were assessed using a well‐established method with five standard platelet agonists. Thirty‐four patients completed the three‐way crossover comparing pre‐ and post‐treatment changes in platelet activation and aggregation studies. There were statistically significant antiplatelet effects with ASA but not with CTD or HCTZ. Hypokalemia occurred in 0 (0%), 10 (30%), and 6 (18%) of the ASA, CTD, and HCTZ patients, respectively. The results of our study suggest that the benefits of CTD and HCTZ in reducing adverse cardiovascular events in patients with hypertension is not a result of an antiplatelet effect. In our study, hypokalemia with CTD was more prevalent than that reported in a large outcome trial in patients with hypertension. The clinical relevance of this finding is uncertain.
Collapse
Affiliation(s)
- Khalid M Bashir
- Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Tammy Burns
- Mary Lanning Healthcare, Hastings, Nebraska, USA
| | | | - Sarah J Aurit
- University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Daniel E Hilleman
- Creighton University School of Pharmacy and Health Professions, Omaha, Nebraska, USA
| |
Collapse
|
3
|
A Validated RP-HPLC Stability Method for the Estimation of Chlorthalidone and Its Process-Related Impurities in an API and Tablet Formulation. Int J Anal Chem 2020; 2020:3593805. [PMID: 32328101 PMCID: PMC7171635 DOI: 10.1155/2020/3593805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/10/2020] [Accepted: 02/27/2020] [Indexed: 11/17/2022] Open
Abstract
Low-dose thiazide and thiazide-like diuretics are widely used as first-line therapy for hypertension. Chlorthalidone, a monosulfamyl diuretic, is frequently prescribed in cases of hypertension and congestive heart failure. In this research paper, an improved reverse-phase HPLC method was developed for the simultaneous identification and quantitation of pharmacopoeia-listed and in-house process- and degradation-related impurities of chlorthalidone in bulk drug and formulations. Chromatographic separation was carried out on a C8 column (250 × 4.6 mm; '5 μm particle size) at a flow rate of 1.4 mL/min with a 220 nm detection wavelength. Mobile phase A consisted of buffer solution (diammonium hydrogen orthophosphate (10 mM, pH 5.5)) and methanol at a 65 : 35 ratio (v/v), and mobile phase B consisted of buffer solution and methanol at a 50 : 50 ratio (v/v). The API and formulation were subjected to stress conditions such as acid, alkali, oxidation, thermal, and photolytic conditions. Validation studies for the in-house process impurities were performed for specificity, limit of detection (LOD), limit of quantitation (LOQ), linearity, precision, accuracy, and robustness. Thus, an improved RP-HPLC method capable of good separation of all known and unknown impurities with acceptable resolution and tailing factor was developed.
Collapse
|
4
|
Braschi A. Potential Protective Role of Blood Pressure-Lowering Drugs on the Balance between Hemostasis and Fibrinolysis in Hypertensive Patients at Rest and During Exercise. Am J Cardiovasc Drugs 2019; 19:133-171. [PMID: 30714087 DOI: 10.1007/s40256-018-00316-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In patients with hypertension, the triad represented by endothelial dysfunction, platelet hyperactivity, and altered fibrinolytic function disturbs the equilibrium between hemostasis and fibrinolysis and translates into a hypercoagulable state, which underlies the risk of thrombotic complications. This article reviews the scientific evidence regarding some biological effects of antihypertensive drugs, which can protect patients from the adverse consequences of hypertensive disease, improving endothelial function, enhancing antioxidant activity, and restoring equilibrium between hemostatic and fibrinolytic factors. These protective effects appear not to be mediated through blood pressure reduction and are not shared by all molecules of the same pharmacological class.
Collapse
Affiliation(s)
- Annabella Braschi
- Ambulatory of Cardiovascular Diseases, Via col. Romey n.10, 91100, Trapani, Italy.
| |
Collapse
|
5
|
Abstract
PURPOSE OF REVIEW In patients with prediabetes or type 2 diabetes, the use of thiazides as antihypertensive agents has been challenged because associated metabolic adverse events, including new-onset diabetes. RECENT FINDINGS These metabolic disturbances are less marked with low-dose thiazides and, in most but not all studies, with thiazide-like diuretics (chlorthalidone, indapamide) than with thiazide-type diuretics (hydrochlorothiazide). In post hoc analyses of subgroups of patients with hypertension and type 2 diabetes, thiazides resulted in a significant reduction in cardiovascular events, all-cause mortality, and hospitalization for heart failure compared to placebo and generally were shown to be non-inferior to other antihypertensive agents. Benefits attributed to thiazide diuretics in terms of cardiovascular event reduction outweigh the risk of worsening glucose control in type 2 diabetes and of new-onset diabetes in non-diabetic patients. Thiazides still play a key role in the management of patients with type 2 diabetes and hypertension.
Collapse
Affiliation(s)
- André J Scheen
- Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine, CHU Liège, University of Liège, CHU Sart Tilman (B35), B-4000, Liege, Belgium.
- Clinical Pharmacology Unit, CHU Liège, Center for Interdisciplinary Research on Medicines (CIRM), University of Liège, Liège, Belgium.
| |
Collapse
|
6
|
Abstract
Although the endothelium has a number of important functions, the term endothelial dysfunction is commonly used to describe impairment in its vasodilatory capacity. It is increasingly recognized that this is related to hypertension, although whether it predates essential hypertension or is a consequence of it is still unknown. In this review, we explore the mechanisms of endothelial dysfunction in essential hypertension, its prognostic significance and methods of pharmacological reversal.
Collapse
|
7
|
Abstract
PURPOSE OF REVIEW To determine usefulness and versatility of hydrochlorothiazide (HCTZ) relative to other thiazide diuretics in the treatment of hypertension. RECENT FINDINGS HCTZ was found to be less potent in lowering blood pressure (BP) than other thiazide diuretics, including chlorthalidone (CTD) and bendroflumethiazide. A recent meta-analysis also suggested HCTZ (12.5-25 mg daily) to be less potent than antihypertensive agents from several other classes, including angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, and calcium antagonists. The risk of hyponatremia, hypokalemia, and hyperuricemia associated with HCTZ was lower than with CTD, while the risk of gouty arthritis was similar. Despite lower risks of metabolic side-effects, meta-analysis of clinical trials showed that, for any given difference in achieved clinic SBP, HCTZ therapy was associated with 18% higher adverse cardiovascular events when compared with CTD. SUMMARY Increasing evidence suggests inferiority of HCTZ in lowering BP and cardiovascular outcomes in hypertensive patients when compared with other drugs in the same class, particularly CTD and indapamide. Thus, HCTZ is neither more useful nor more versatile than other thiazide diuretics. CTD and indapamide should be preferred over HCTZ in most hypertensive patients when diuretics are required for treatment of hypertension.
Collapse
|
8
|
Roush GC, Buddharaju V, Ernst ME, Holford TR. Chlorthalidone: Mechanisms of Action and Effect on Cardiovascular Events. Curr Hypertens Rep 2013; 15:514-21. [DOI: 10.1007/s11906-013-0372-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
9
|
Gene panels to help identify subgroups at high and low risk of coronary heart disease among those randomized to antihypertensive treatment: the GenHAT study. Pharmacogenet Genomics 2012; 22:355-66. [PMID: 22388798 DOI: 10.1097/fpc.0b013e3283516ff8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To identify panels of genetic variants that predict treatment-related coronary heart disease (CHD) outcomes in hypertensive patients on one of four different classes of initial antihypertensive treatment. The goal was to identify subgroups of individuals on the basis of their genetic profile who benefit most from a particular treatment. METHODS Candidate genetic variants (n=78) were genotyped in 39 114 participants from Genetics of Hypertension Associated Treatment study, ancillary to Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial. Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial randomized hypertensive participants (≥55 years) to one of four treatments (amlodipine, chlorthalidone, doxazosin, lisinopril). The primary outcome was fatal CHD or nonfatal myocardial infarction (mean follow-up=4.9 years). A pharmacogenetic panel was derived within each of the four treatment groups. Receiver-operating characteristic (ROC) curves estimated the discrimination rate between those with and without a CHD event, on the basis of the addition of the genetic panel risk score. RESULTS For each treatment group, we identified a panel of genetic variants that collectively improved the prediction of CHD to a small but statistically significant extent. Chlorthalidone (A): NOS3 rs3918226; SELE rs5361; ICAM1 rs1799969; AGT rs5051; GNAS rs7121; ROC comparison, P=0.004; Amlodipine (B): MMP1 rs1799750; Factor5 (F5) rs6025; NPPA rs5065; PDE4D rs6450512; MMP9 rs2274756; ROC comparison, P=0.006; Lisinopril (C): AGT rs5051; PON1 rs705379; MMP12 rs652438; F12 rs1801020; GP1BA rs6065; PDE4D rs27653; ROC comparison, P=0.01; Doxazosin (D): F2 rs1799963; PAI1 rs1799768; MMP7 rs11568818; AGT rs5051; ACE rs4343; MMP2 rs243865; ROC comparison, P=0.007. Each panel was tested for a pharmacogenetic effect; panels A, B, and D showed such evidence (P=0.009, 0.006, and 0.001, respectively) and panel C did not (P=0.09). CONCLUSION Because each panel was associated with CHD in a specific treatment group but not the others, this research provides evidence that it may be possible to use gene panel scores as a tool to better assess antihypertensive treatment choices to reduce CHD risk in hypertensive individuals.
Collapse
|
10
|
Alterio V, Di Fiore A, D'Ambrosio K, Supuran CT, De Simone G. Multiple binding modes of inhibitors to carbonic anhydrases: how to design specific drugs targeting 15 different isoforms? Chem Rev 2012; 112:4421-68. [PMID: 22607219 DOI: 10.1021/cr200176r] [Citation(s) in RCA: 933] [Impact Index Per Article: 77.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Vincenzo Alterio
- Istituto di Biostrutture e Bioimmagini-CNR, via Mezzocannone 16, 80134 Napoli, Italy
| | | | | | | | | |
Collapse
|
11
|
Temperini C, Cecchi A, Scozzafava A, Supuran CT. Carbonic anhydrase inhibitors. Comparison of chlorthalidone, indapamide, trichloromethiazide, and furosemide X-ray crystal structures in adducts with isozyme II, when several water molecules make the difference. Bioorg Med Chem 2009; 17:1214-21. [DOI: 10.1016/j.bmc.2008.12.023] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 12/09/2008] [Accepted: 12/12/2008] [Indexed: 10/21/2022]
|
12
|
Temperini C, Cecchi A, Scozzafava A, Supuran CT. Carbonic Anhydrase Inhibitors. Comparison of Chlorthalidone and Indapamide X-ray Crystal Structures in Adducts with Isozyme II: When Three Water Molecules and the Keto−Enol Tautomerism Make the Difference. J Med Chem 2008; 52:322-8. [DOI: 10.1021/jm801386n] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Claudia Temperini
- Laboratorio di Chimica Bioinorganica, Università degli Studi di Firenze, Rm. 188, Via della Lastruccia 3, I-50019 Sesto Fiorentino, Firenze, Italy
| | - Alessandro Cecchi
- Laboratorio di Chimica Bioinorganica, Università degli Studi di Firenze, Rm. 188, Via della Lastruccia 3, I-50019 Sesto Fiorentino, Firenze, Italy
| | - Andrea Scozzafava
- Laboratorio di Chimica Bioinorganica, Università degli Studi di Firenze, Rm. 188, Via della Lastruccia 3, I-50019 Sesto Fiorentino, Firenze, Italy
| | - Claudiu T. Supuran
- Laboratorio di Chimica Bioinorganica, Università degli Studi di Firenze, Rm. 188, Via della Lastruccia 3, I-50019 Sesto Fiorentino, Firenze, Italy
| |
Collapse
|
13
|
Levy BI, Schiffrin EL, Mourad JJ, Agostini D, Vicaut E, Safar ME, Struijker-Boudier HA. Impaired Tissue Perfusion. Circulation 2008; 118:968-76. [DOI: 10.1161/circulationaha.107.763730] [Citation(s) in RCA: 328] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Bernard I. Levy
- From Centre de Recherche Cardiovasculaire de Lariboisière, INSERM U689, Service d'Explorations Fonctionnelles, Hôpital Lariboisière (B.I.L.), Paris, France; Lady Davis Institute of Medical Research and Department of Medicine, Sir Mortimer B. Davis–Jewish General Hospital, McGill University (E.L.S.), Montreal, Quebec, Canada; Département de Médecine Interne, Hôpital Avicenne (J.-J.M.), Bobigny, France; UF Médecine Nucléaire, CHU Côte de Nacre (D.A.), Caen, France; Laboratoire d'étude de la
| | - Ernesto L. Schiffrin
- From Centre de Recherche Cardiovasculaire de Lariboisière, INSERM U689, Service d'Explorations Fonctionnelles, Hôpital Lariboisière (B.I.L.), Paris, France; Lady Davis Institute of Medical Research and Department of Medicine, Sir Mortimer B. Davis–Jewish General Hospital, McGill University (E.L.S.), Montreal, Quebec, Canada; Département de Médecine Interne, Hôpital Avicenne (J.-J.M.), Bobigny, France; UF Médecine Nucléaire, CHU Côte de Nacre (D.A.), Caen, France; Laboratoire d'étude de la
| | - Jean-Jacques Mourad
- From Centre de Recherche Cardiovasculaire de Lariboisière, INSERM U689, Service d'Explorations Fonctionnelles, Hôpital Lariboisière (B.I.L.), Paris, France; Lady Davis Institute of Medical Research and Department of Medicine, Sir Mortimer B. Davis–Jewish General Hospital, McGill University (E.L.S.), Montreal, Quebec, Canada; Département de Médecine Interne, Hôpital Avicenne (J.-J.M.), Bobigny, France; UF Médecine Nucléaire, CHU Côte de Nacre (D.A.), Caen, France; Laboratoire d'étude de la
| | - Denis Agostini
- From Centre de Recherche Cardiovasculaire de Lariboisière, INSERM U689, Service d'Explorations Fonctionnelles, Hôpital Lariboisière (B.I.L.), Paris, France; Lady Davis Institute of Medical Research and Department of Medicine, Sir Mortimer B. Davis–Jewish General Hospital, McGill University (E.L.S.), Montreal, Quebec, Canada; Département de Médecine Interne, Hôpital Avicenne (J.-J.M.), Bobigny, France; UF Médecine Nucléaire, CHU Côte de Nacre (D.A.), Caen, France; Laboratoire d'étude de la
| | - Eric Vicaut
- From Centre de Recherche Cardiovasculaire de Lariboisière, INSERM U689, Service d'Explorations Fonctionnelles, Hôpital Lariboisière (B.I.L.), Paris, France; Lady Davis Institute of Medical Research and Department of Medicine, Sir Mortimer B. Davis–Jewish General Hospital, McGill University (E.L.S.), Montreal, Quebec, Canada; Département de Médecine Interne, Hôpital Avicenne (J.-J.M.), Bobigny, France; UF Médecine Nucléaire, CHU Côte de Nacre (D.A.), Caen, France; Laboratoire d'étude de la
| | - Michel E. Safar
- From Centre de Recherche Cardiovasculaire de Lariboisière, INSERM U689, Service d'Explorations Fonctionnelles, Hôpital Lariboisière (B.I.L.), Paris, France; Lady Davis Institute of Medical Research and Department of Medicine, Sir Mortimer B. Davis–Jewish General Hospital, McGill University (E.L.S.), Montreal, Quebec, Canada; Département de Médecine Interne, Hôpital Avicenne (J.-J.M.), Bobigny, France; UF Médecine Nucléaire, CHU Côte de Nacre (D.A.), Caen, France; Laboratoire d'étude de la
| | - Harry A.J. Struijker-Boudier
- From Centre de Recherche Cardiovasculaire de Lariboisière, INSERM U689, Service d'Explorations Fonctionnelles, Hôpital Lariboisière (B.I.L.), Paris, France; Lady Davis Institute of Medical Research and Department of Medicine, Sir Mortimer B. Davis–Jewish General Hospital, McGill University (E.L.S.), Montreal, Quebec, Canada; Département de Médecine Interne, Hôpital Avicenne (J.-J.M.), Bobigny, France; UF Médecine Nucléaire, CHU Côte de Nacre (D.A.), Caen, France; Laboratoire d'étude de la
| |
Collapse
|
14
|
Carter BL, Sica DA. Strategies to improve the cardiovascular risk profile of thiazide-type diuretics as used in the management of hypertension. Expert Opin Drug Saf 2007; 6:583-94. [PMID: 17877445 DOI: 10.1517/14740338.6.5.583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Thiazide diuretics are one of the preferred pharmacologic treatments for hypertension. However, there has been rather pointed debate during the past 20 years about the clinical significance of the biochemical and/or metabolic adverse effects caused by diuretics. This controversy centers around whether the hypokalemia, hypomagnesemia, hyperuricemia, hyperglycemia and/or hyperlipidemia occasionally seen with diuretics might lessen some of the beneficial effects on cardiovascular risk seen with reductions in blood pressure. One of the biggest controversies in the last few years has focused on whether the small increase in absolute risk of diabetes seen with diuretic therapy should be a concern. The vigilant clinician should appropriately dose and monitor diuretic therapy either when given alone or when used in combination therapy. When these strategies are employed, the adverse effects seen with diuretics can be minimized or negated, and in so doing cardiovascular benefits can be optimized.
Collapse
Affiliation(s)
- Barry L Carter
- University of Iowa, Division of Clinical and Administrative Pharmacy, College of Pharmacy, Department of Family Medicine, Building S 532, Iowa City, Iowa 52242, USA.
| | | |
Collapse
|
15
|
Okon EB, Chung AWY, Zhang H, Laher I, van Breemen C. Hyperglycemia and hyperlipidemia are associated with endothelial dysfunction during the development of type 2 diabetes. Can J Physiol Pharmacol 2007; 85:562-7. [PMID: 17632592 DOI: 10.1139/y07-026] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Diabetes mellitus impairs endothelial function, which can be considered as the hallmark in the development of cardiovascular diseases. Hyperglycemia, hyperinsulinemia, and hyperlipidemia are believed to contribute to endothelial dysfunction. In the present study, we investigated the possible links among these plasma metabolic markers and endothelial function in a mouse model during the development of type 2 diabetes. C57BL/6J-Lepob/ob mice at 8, 12, and 16 weeks were used to study endothelial function during the establishment of type 2 diabetes. Endothelial function was accessed in vitro in the thoracic aorta by measuring acetylcholine (ACh)-stimulated vasodilatation. Blood plasma was obtained for the measurements of glucose, insulin, triglycerides, and cholesterol levels. Correlation and multiple regression analysis revealed strong negative associations between the ACh responsiveness and the plasma levels of glucose, insulin, and lipid profiles at the age of 8 weeks. Associations were observed at neither older age nor in C57BL/6J mice. In conclusion, the increase in plasma levels of glucose, insulin, and lipids is associated with the impairment of the endothelial function during the early stage of the development of type 2 diabetes. The loss of correlation at an older age suggests multifactorial regulation of endothelial function and cardiovascular complications at later stages of the disease.
Collapse
Affiliation(s)
- Elena B Okon
- James Hogg iCAPTURE Centre for Cardiovascular and Pulmonary Research, St. Paul's Hospital, 1081 Burrard Street, University of British Columbia, Vancouver, BC V6Z 1Y6, Canada.
| | | | | | | | | |
Collapse
|