CLICK

Clinical Question

In patients with advanced chronic kidney disease and poorly controlled hypertension, does addition of chlorthalidone to antihypertensive regimen improve blood pressure and albuminuria?

Bottom Line

Addition of chlorthalidone in those with stage IV CKD and poorly controlled hypertension improves blood pressure at 12 weeks.

Major Points

Chlorthalidone's efficacy and safety in patients with advanced chronic kidney disease was unknown. The CLICK trial demonstrated that use of chlorthalidone improves blood pressure in this population.

Design

• Single center, double-blind, randomized, controlled trial
• N=160
  • Chlorthalidone (n=81)
  • Placebo (n=79)
• Setting: Single center in the United States
• Enrollment:
• Mean follow-up:
• Analysis: Intention-to-treat
• Primary outcome: change in 24-hour ambulatory systolic blood pressure from baseline to 12 weeks

Population

Inclusion Criteria

• Stage 4 chronic kidney disease (eGFR 15 to <30 mL/min/1.73 m**2 of body-surface area)
• Uncontrolled hypertension confirmed by 24-hour ambulatory blood-pressure of 130 mm Hg or higher (systolic) or 80 mm Hg or higher (diastolic) while receiving at least one antihypertensive drug (angiotensin-converting-enzyme inhibitor or angiotensin-receptor blocker or a beta-blocker)

Exclusion Criteria

• 24-hour ambulatory blood pressure of 160 mm Hg or higher (systolic) or 100 mm Hg or higher (diastolic)
• Prior stroke or myocardial infarction
• Hospitalized within 12 weeks before randomization
• Receiving high-dose loop diuretics (>200 mg of furosemide daily or >100 mg of torsemide daily)
• Received a thiazide or a thiazide-like diuretic within 12 weeks before randomization

Baseline Characteristics

• Mean age: 66 years
• Mean BMI: 33
• Mean eGFR: 23.2 mL/min/1.73 m**2
• Mean systolic blood pressure: 140.0 mm Hg
• Mean diastolic blood pressure: 68.6 mm Hg