Journal Article

Comparison of thiazide‐like diuretics versus thiazide‐type diuretics: a meta‐analysis

Liang, Wenjing, Yan, Wenjiang, Yang, Jingjing, Cao, Luxi, Ma, Hui

2017

Overview

Thiazide diuretics are widely used for the management of hypertension. In recent years, it has been actively debated that there is interchangeability of thiazide‐type diuretics hydrochlorothiazide and thiazide‐like diuretics including indapamide and chlorthalidone for the treatment of hypertension. With the purpose of seeking out the best thiazide diuretic for clinicians, we summarized the existing evidence on the two types of drugs and conducted a meta‐analysis on their efficacy in lowering blood pressure and effects on blood electrolyte, glucose and total cholesterol. Twelve trials were identified: five based on the comparison of indapamide versus hydrochlorothiazide and seven based on the chlorthalidone versus hydrochlorothiazide. In the meta‐analysis of blood pressure reduction, thiazide‐like diuretics seemed to further reduce systolic BP ([95% CI]; −5.59 [−5.69, −5.49]; P < 0.001) and diastolic BP ([95% CI]; −1.98 [−3.29, −0.66]; P = 0.003). Meanwhile, in the analysis of side effects, the incidence of hypokalemia ([95% CI]; 1.58 [0.80, 3.12]; P = 0.19), hyponatremia ([95% CI]; −0.14 [−0.57, 0.30], P = 0.54), change of blood glucose ([95% CI];0.13 [−0.16, 0.41], P = 0.39) and total cholesterol ([95% CI]; 0.13 [−0.16, 0.41], P = 0.39) showed that there is no statistical significant differences between the two groups of drugs. In conclusion, using thiazide‐like diuretics is superior to thiazide‐type diuretics in reducing blood pressure without increasing the incidence of hypokalemia, hyponatraemia and any change of blood glucose and serum total cholesterol.

• Publisher: John Wiley & Sons, Inc,John Wiley and Sons Inc
• Subject: Antihypertensive Agents - administration & dosage / Antihypertensive Agents - adverse effects / Blood Glucose - metabolism / Blood pressure / Blood Pressure - drug effects / Chlorthalidone - administration & dosage / Chlorthalidone - adverse effects / Cholesterol / Cholesterol - blood / Diuretics / Diuretics - administration & dosage / Diuretics - adverse effects / Glucose / Humans / Hydrochlorothiazide / Hydrochlorothiazide - administration & dosage / Hydrochlorothiazide - adverse effects / Hypertension / Hypertension - blood / Hypertension - drug therapy / Hypertension - physiopathology / Hypokalemia / Hypokalemia - chemically induced / Hypokalemia - diagnosis / Hyponatremia / Hyponatremia - chemically induced / Hyponatremia - diagnosis / Indapamide / Indapamide - administration & dosage / Indapamide - adverse effects / Meta-analysis / Review / Reviews / Statistical analysis / thiazide‐like diuretics / thiazide‐type diuretics / Treatment Outcome / Water-Electrolyte Balance - drug effects