Meta-analysis of Health Outcomes of Chlorthalidone-Based vs Nonchlorthalidone-Based Low-Dose Diuretic Therapies

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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.