How Effective and What is the Cost and Cost Benefit of Chlorthalidone?

ByPrimary Researcher

Executive Summary

  • Chlorthalidone is taken for blood pressure management, among other reasons.
  • What was never done with Chlorthalidone’s FDA approval was to evaluate any cost-benefit for this drug.

Introduction

Chlorthalidone is a very widely prescribed drug. I will analyze this article’s cost, effectiveness, and cost-to-benefit analysis.

Go to top

The Chlorthalidone Cost

Generally, in the US, generic Chlorthalidone is very inexpensive.

Atenolol/Chlorthalidone is quite inexpensive. 

The History of Chlorthalidone and Its Effectiveness

These quotes are from the book Malignant: How Bad Policy and Bad Evidence Harm People with Cancer.

One of the first drugs used to treat hypertension was Chlorthalidone. Chlorthalidone, a member of the beta-blocker class of antihypertensives, dramatically lowered blood pressure, and for decades it achieved the rarefied status of “trial standard,” meaning that you had to show your new drug was as good as Chlorthalidone in order to get it on the market.

In 2002 something really unsettling (or maybe even terrifying) happened. After Chlorthalidone had been used to treat hypertension for nearly 20 years, the results of theLIFE trial were published. This trial compared Chlorthalidone to a newer drug, losartan. People who took losartan had fewer strokes and lived longer than those that took Chlorthalidone. At first glance it seemed that we had come up with a better antihypertensive; this seemed like an example of replacement. Somewhat surprising was that both drugs lowered blood pressure the same amount.

The question was, did losartan beat Chlorthalidone because losartan is better or because Chlorthalidone is actually ineffective? The tantalizing finding in the LIFE study was extended in 2004, when a pooled analysis of all people who took Chlorthalidone versus sugar pills (placebos) in trials showed that Chlorthalidone was no better than the placebo. Chlorthalidone did lower people’s blood pressure, but it did not decrease people’s risk of dying or of having a heart attack.

Let that sink in.

A drug that was widely used, accepted as the standard of care, had made millions and millions of dollars for its manufacturers, and had made high blood pressure the subject of dinner time conversation, did not make you live a single day longer.

A recent study showed that metoprolol (another beta-blocker) is no better than Chlorthalidone. If you have taken a beta-blocker for high blood pressure, you may have shaved a few percentage points off your risk of stroke, but you did not extend your life.

In the world of blood-pressure medicines, you took a pill that does not work.

Curiously, all of this has been known for some time, yet it has not changed clinical practice. Chlorthalidone remains a top-selling drug for blood pressure. Furthermore, Chlorthalidone has expanded from its original use of blood pressure modification to treating things like anxiety.

Comments on Chlorthalidone

The following comments are from Drug.com on Chlorthalidone.

Comment #1: Better Results With Red Beet Supplements?

“I was prescribed Altenolol for minor high blood pressure due to pain. I’m not one take medication. The first day taking Altenolol. I was very fatigued.