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Should we switch from bendrofluazide to chlorthalidone as the initial treatment for hypertension? A review of the available medication.
ABSTRACT AIM: To determine if bendroflumethiazide/bendrofluazide (BDFZ), the most commonly used diuretic for hypertension in New Zealand, is as effective as other diuretics in terms of cardiovascular outcomes (CVD). METHODS Using recent reviews of thiazide-like (chlorthalidone (CTDN) or indapamide) and thiazide-type diuretics (hydrochlorothiazide (HCTZ) and bendrofluazide (BDFZ)) and a separate search of BDFZ, data on CVD outcomes was extracted. RESULTS We found 19 relevant papers with 21 comparisons. All thiazide-based diuretics report at least one trial showing them to be more effective than placebo for CVD outcomes other than chlorothiazide. There were no comparisons of BDFZ alone with other medications but there were two studies with either BDFZ or HCTZ compared with betablockers but the pooled RR was not significant RR = 1.10 (95% CI, 0.84-1.43). For CTDN there were 4 comparisons with other medications and the summary relative risk was statistically significant for CVD outcomes 0.91 (95% CI, 0.85-0.98). CTDN was significantly more effective for some CVD outcomes when compared with doxazosin, amlodipine and lisinopril. CONCLUSIONS All thiazide based medicine available in New Zealand are effective compared with placebo when used for treating hypertension in terms of cardiovascular outcomes other than chlorothiazide. Of diuretics available in New Zealand for hypertension only CTDN has been shown to be more effective than other blood pressure lowering medicines. It may be time to change from using BDFZ and start using CTDN as a treatment for hypertension.
HC16038 Accepted 19 March 2017
© CSIRO 2017