Chlorthalidone for Hypertension in Advanced Chronic Kidney Disease

This double-blind, placebo-controlled trial (CLICK) evaluated chlorthalidone in 160 patients with stage 4 chronic kidney disease and uncontrolled hypertension. Participants were randomized to chlorthalidone or placebo over 12 weeks, with dose escalation from 12.5 mg up to 50 mg. Chlorthalidone reduced 24-hour ambulatory systolic blood pressure by 11.0 mm Hg (vs. 0.5 mm Hg for placebo), yielding a between-group difference of −10.5 mm Hg (P<0.001). It also lowered urinary albumin-to-creatinine ratio by 50 percentage points, NT-proBNP levels, and total body volume, indicating improved cardiovascular and renal outcomes. Adverse effects including hypokalemia, reversible creatinine elevation, and hyperglycemia, were more frequent with chlorthalidone. The study supports chlorthalidone’s efficacy and tolerability as a blood pressure–lowering strategy in advanced CKD.

This double-blind, placebo-controlled trial (CLICK) evaluated chlorthalidone in 160 patients with stage 4 chronic kidney disease and uncontrolled hypertension. Participants were randomized to chlorthalidone or placebo over 12 weeks, with dose escalation from 12.5 mg up to 50 mg. Chlorthalidone reduced 24-hour ambulatory systolic blood pressure by 11.0 mm Hg (vs. 0.5 mm Hg for placebo), yielding a between-group difference of −10.5 mm Hg (P<0.001). It also lowered urinary albumin-to-creatinine ratio by 50 percentage points, NT-proBNP levels, and total body volume, indicating improved cardiovascular and renal outcomes. Adverse effects including hypokalemia, reversible creatinine elevation, and hyperglycemia, were more frequent with chlorthalidone. The study supports chlorthalidone’s efficacy and tolerability as a blood pressure–lowering strategy in advanced CKD.