Chlortalidone: Outdated or Reborn?

Most current guidelines on hypertension regard thiazide and thiazide-like diuretics as equivalent for the first-line treatment of essential hypertension. However, hydrochlorothiazide has been favoured over the thiazide-like chlortalidone in clinical practice for unclear reasons. Although definite scientific evidence is lacking, an objective analysis of the literature indicates that chlortalidone is superior to hydrochlorothiazide regarding blood pressure control and major health outcomes. Haemodynamic, as well as nonhaemo dynamic pleomorphic effects could account for these differences. Moreover, the safety profiles of the two molecules seem comparable. Initial concerns about adverse effects, the relative lack of single-pill combination and economical interests have presumably prevented the widespread use of chlortalidone over the years. Based on the available evidence, we think that chlortalidone and thiazide diuretics should not be regarded as equivalent and encourage clinicians to consider chlortalidone as a potential first-line antihypertensive agent.