Twelve weeks of treatment with the thiazide diuretic chlorthalidone led to about an average 10 mmHg cut in systolic blood pressure in patients with treatment-resistant hypertension and advanced stage 4 chronic kidney disease in a randomized study with 160 patients.
Results from the CLICK trial have disproved conventional wisdom that thiazide diuretics are ineffective in patients with an estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73m2.
The findings also appear to cement a role for chlorthalidone as a new option for reducing systolic blood pressure in patients with stage 4 chronic kidney disease (CKD) (eGFR 15-29 mL/min/1.73m2) who remain hypertensive despite treatment with several antihypertensive agents.
"We were fooled that thiazide diuretics don't work in patients with advanced CKD, but chlorthalidone is very good at lowering blood pressure on top of three or four other medications. It lowered systolic blood pressure by an average of about 10 mmHg, a very good result," said Rajiv Agarwal, MD, who presented the results during virtual Kidney Week 2021, sponsored by the American Society of Nephrology.
The results were simultaneously published in The New England Journal of Medicine.
"Treatment of refractory hypertension in patients with CKD is very challenging. I think chlorthalidone will be adopted into practice based on these data," commented
