Chlorthalidone for poorly controlled hypertension in chronic kidney disease: An interventional pilot study

Rajiv Agarwal, Arjun Sinha, Maria K. Pappas, Farah Ammous

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

To test the hypothesis that thiazide-type diuretics effectively lower blood pressure (BP) in moderate to advanced chronic kidney disease (CKD; estimated GFR 20-45 ml/min/1.73 m2), after confirming poorly controlled hypertension with 24-hour ambulatory BP monitoring, chlorthalidone was added to existing medications in a dose of 25 mg/day, and the dose doubled every 4 weeks if the BP remained elevated. The average age of the 14 subjects was 67.5 years, a median of 4 antihypertensive drugs were used and estimated GFR was 26.8 ± 8.8 ml/min/1.73 m2. Twelve subjects completed the 12-week treatment phase, and the 24-hour BP, which was 143.1/75.1 mm Hg at baseline, was reduced by 10.5/3.1 mm Hg (p = 0.01/p = 0.17). Home BP prior to initiating chlorthalidone was 152.4/82.6 mm Hg and fell at 4, 8, and 12 weeks by 10.2/4.8, 13.4/6.0, and 9.4/3.7 mm Hg (all p <0.05). Maximal reduction in body weight and total body volume (measured by air displacement plethysmography) was seen at 8 weeks, concurrent with the maximal elevation in serum creatinine concentration and plasma renin activity. Albuminuria was significantly reduced by 40-45%. Adverse events were seen following chlorthalidone therapy in 7 subjects who experienced 18 events as follows: hypokalemia (n = 4), hyperuricemia (4), hyponatremia (3), transient creatinine changes (3), dizziness (2), hyperglycemia (1), and constipation (1). One subject had ischemic stroke during the study. In conclusion, among people with moderate to advanced CKD with poorly controlled hypertension, chlorthalidone may significantly reduce BP via volume contraction; a randomized trial is needed to define the risks and benefits. Adverse effects may occur within a few weeks and should be carefully monitored.

Original languageEnglish (US)
Pages (from-to)171-182
Number of pages12
JournalAmerican Journal of Nephrology
Volume39
Issue number2
DOIs
StatePublished - 2014

Fingerprint

Chlorthalidone
Chronic Renal Insufficiency
Blood Pressure
Hypertension
Creatinine
Sodium Chloride Symporter Inhibitors
Hyperuricemia
Ambulatory Blood Pressure Monitoring
Albuminuria
Plethysmography
Hypokalemia
Hyponatremia
Dizziness
Constipation
Renin
Hyperglycemia
Antihypertensive Agents
Stroke
Air
Body Weight

Keywords

  • Blood pressure
  • Chlorthalidone
  • Chronic kidney disease
  • Estimated GFR

ASJC Scopus subject areas

  • Nephrology

Cite this

Chlorthalidone for poorly controlled hypertension in chronic kidney disease : An interventional pilot study. / Agarwal, Rajiv; Sinha, Arjun; Pappas, Maria K.; Ammous, Farah.

In: American Journal of Nephrology, Vol. 39, No. 2, 2014, p. 171-182.

Research output: Contribution to journalArticle

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