Hydrochlorothiazide: is it a wise choice?

Hydrochlorothiazide (HCTZ) has not been shown to reduce mortality or cardiovascular events when given as a single agent. In fact, HCTZ increased cardiovascular death and coronary artery disease (CAD) compared to placebo and usual care in 2 randomized trials, yet it is the most prescribed diuretic in the United States (U.S.). The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure does not recommend one thiazide diuretic over another. However, there are more clinical data for chlorthalidone and indapamide than HCTZ. This review summarizes the differences between HCTZ, chlorthalidone and indapamide for pharmacological profile, surrogate marker data and clinical trial data. The use of the term 'thiazide diuretic' should be replaced with 'non-thiazide sulfonamide diuretic' for chlorthalidone and indapamide. Furthermore, chlorthalidone and indapamide, rather than HCTZ, should be recommended due to the lack of evidence and potential harm of the latter.