INTRODUCTION
Thiazide diuretics are commonly prescribed in the treatment of
hypertension. However,
thiazide diuretics may not all be equal in their ability to reduce
cardiovascular disease outcomes. AIM To determine if
bendroflumethiazide/
bendrofluazide, the most commonly used
diuretic for
hypertension in New Zealand, is as effective as other
diuretics in terms of
cardiovascular disease outcomes. METHODS Using recent reviews of
thiazide-like (
chlorthalidone or
indapamide) and
thiazide-type
diuretics (
hydrochlorothiazide and
bendrofluazide) and a separate search of
bendrofluazide, data on
cardiovascular disease outcomes was extracted. RESULTS Nineteen relevant papers with 21 comparisons were found. All
thiazide-based
diuretics have been reported in at least one trial showing them to be more effective than placebo for
cardiovascular disease outcomes, with the exception of
chlorothiazide. There were no comparisons of
bendrofluazide alone with other medications, but there were two studies with either
bendrofluazide or
hydrochlorothiazide compared with β-blockers; however, the pooled relative risk (RR) was not significant (RR = 1.10 (95% CI, 0.84-1.43)). For
chlorthalidone, there were four comparisons with other medications, and the summary RR was statistically significant for
cardiovascular disease outcomes (RR = 0.91 (95% CI, 0.85-0.98)).
Chlorthalidone was significantly more effective for some
cardiovascular disease outcomes when compared with
doxazosin,
amlodipine and
lisinopril. CONCLUSIONS All
thiazide-based medicines available in New Zealand are effective in terms of
cardiovascular disease outcomes compared with placebo when used for treating
hypertension, with the exception of
chlorothiazide. Of the
diuretics available in New Zealand for
hypertension, only
chlorthalidone has been shown to be more effective than other blood pressure-lowering medicines. It may be time to change from using
bendrofluazide and start using
chlorthalidone as a treatment for
hypertension.