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The Diuretic Comparison Project — a randomized trial in which nearly 14,000 older patients (age, ≥65) with hypertension received hydrochlorothiazide (HCTZ) or chlorthalidone — showed no difference between groups in adverse cardiovascular outcomes (NEJM JW Gen Med Jan 15 2023 and N Engl J Med 2022; 387:2401). In this secondary analysis, the researchers examined renal endpoints, motivated in part by several recent observational studies that suggested slightly worse renal outcomes with chlorthalidone compared with HCTZ (NEJM JW Gen Med Mar 15 2020 and JAMA Intern Med 2020; 180:542; and JAMA Network Open 2021; 4:e2123365).
At baseline, mean estimated glomerular filtration rate (eGFR) was 71 mL/minute/1.73 m2; three quarters of patients had eGFR …