Can Chlorthalidone Lower Blood Pressure in Patients with Advanced Kidney Disease?

Literature published decades ago suggested that thiazide diuretics lose their antihypertensive effects in patients with advanced chronic kidney disease (CKD). Consequently, many of us were taught to discontinue thiazides when serum creatinine levels exceeded roughly 2 mg/dL. However, more-recent data indicate that thiazides might lower blood pressure (BP) even in patients with substantially impaired renal function.

In this trial, researchers randomized 160 patients with hypertension and stage 4 CKD (mean estimated glomerular filtration rate, 23 mL/minute/1.73 m²) to receive either the thiazide-like diuretic chlorthalidone or placebo. Enrollment criteria included 24-hour ambulatory BP of 130 to 160 mm Hg (systolic) or 80 to 100 mm Hg (diastol…