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Research · Medication

Thiazide diuretics

Pooled trials found low-dose thiazides lowered blood pressure, stroke by about a third and deaths by 11%. The one large head-to-head trial found no difference in heart events between chlorthalidone and hydrochlorothiazide, with more low potassium on chlorthalidone. Hydrochlorothiazide was linked to a small rise in skin cancer, mainly squamous cell carcinoma.

Add to Bio HackChecked 2026-11-13
Status
Prescription drugs in the US. Hydrochlorothiazide is FDA-approved for high blood pressure and for edema from heart failure, cirrhosis, kidney disease, and corticosteroid or estrogen therapy. Chlorthalidone is approved for high blood pressure and edema.
Also called
hydrochlorothiazide, HCTZ, Microzide, chlorthalidone, Thalitone, Hygroton, indapamide, thiazide-like diuretic, water pill
Taken for
high blood pressure, heart attack and stroke prevention, fluid retention and swelling, kidney stone prevention, bone protection

Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on

Shown to help3

Reported risks14

What people take it for, and what was found

Shown to help3

Strong

Lowering blood pressure

Shown to lower blood pressure by dose, about 8/3 mm Hg on hydrochlorothiazide 25 mg and 12/4 mm Hg on chlorthalidone in adults with high blood pressure.

The numbers and sources
Effect
In 33 placebo-controlled trials, hydrochlorothiazide at 6.25, 12.5, 25 and 50 mg a day lowered blood pressure by 4/2, 6/3, 8/3 and 11/5 mm Hg. In 7 trials, chlorthalidone at 12.5 to 75 mg a day lowered it by 12.0/4 mm Hg, with no evidence that higher doses lowered it more [1]. A separate analysis of 354 trials found thiazides lowered blood pressure by about the same amount as the other main drug classes, on average 9.1/5.5 mm Hg at standard dose [2]. In stage 4 chronic kidney disease, chlorthalidone lowered 24-hour systolic pressure by 10.5 mm Hg more than placebo at 12 weeks (95% CI 6.4 to 14.6) [3].
Population
11,282 people in 60 trials of six thiazides, mean age 55, treated a mean 8 weeks [1]; about 40,000 treated and 16,000 placebo participants in 354 trials [2]; 160 people with stage 4 chronic kidney disease and poorly controlled hypertension [3].
Sources
[1], [2], [3]
Caveats
The chlorthalidone trials started from a different baseline pressure (163/88 against 155/100 mm Hg), so the two drugs' figures are not a direct comparison. Most trials were at unclear or high risk of bias [1].
Moderate

Heart attack, stroke and death

Shown to lower stroke from 6.2% to 4.2%, coronary heart disease from 3.9% to 2.8% and deaths from 11.0% to 9.8% as first-line low-dose treatment.

The numbers and sources
Effect
A Cochrane review found first-line low-dose thiazides lowered mortality (11.0% with control against 9.8%, RR 0.89, 95% CI 0.82 to 0.97), total cardiovascular events (12.9% against 9.0%, RR 0.70), stroke (6.2% against 4.2%, RR 0.68, 95% CI 0.60 to 0.77) and coronary heart disease (3.9% against 2.8%, RR 0.72). High-dose thiazides lowered stroke (RR 0.47) and total cardiovascular events (RR 0.72) and did not lower mortality [4]. In the SHEP trial of chlorthalidone-based treatment, the 5-year incidence of stroke was 5.2 per 100 on treatment and 8.2 on placebo (RR 0.64), with major cardiovascular events also lower (RR 0.68) [5]. In ALLHAT, chlorthalidone did not differ from amlodipine or lisinopril on fatal coronary disease or nonfatal heart attack, and had a lower 6-year rate of heart failure than either (7.7% against 10.2% and 8.7%) [6].
Population
58,040 people in 24 trials across drug classes, mean age 56, followed 3 to 5 years [4]; 4,736 adults aged 60 and over with isolated systolic hypertension, mean age 72 [5]; 33,357 adults aged 55 or older in ALLHAT [6].
Sources
[4], [5], [6]
Caveats
The Cochrane authors rated the low-dose evidence high quality and the high-dose evidence low to moderate [4]. The two named trials used chlorthalidone.
Moderate

Fractures

Linked to about 14% fewer fractures in cohort studies. In one randomized trial, chlorthalidone brought fewer hip and pelvic fractures than amlodipine or lisinopril.

The numbers and sources
Effect
In 11 cohort studies, thiazide users had fewer fractures of any kind than non-users (RR 0.86, 95% CI 0.80 to 0.93) and fewer hip fractures (RR 0.82). The effect was weaker in the higher-quality studies [15]. In a secondary analysis of ALLHAT, people randomized to chlorthalidone had fewer hip and pelvic fractures during the trial than those on amlodipine or lisinopril (HR 0.79, 95% CI 0.63 to 0.98). Over the trial plus later follow-up the difference was not significant (HR 0.87, 95% CI 0.74 to 1.03) [16].
Population
2,193,160 participants in 11 cohort studies [15]; 22,180 ALLHAT participants with a mean age of 70.4, followed up to 8 years in the trial [16].
Sources
[15], [16]
Caveats
The cohort studies are observational. The randomized evidence is a secondary analysis against other drugs, not placebo [16].

Mixed results2

Moderate

Chlorthalidone compared with hydrochlorothiazide

Mixed results: indirect comparisons favored chlorthalidone, and the one large head-to-head trial found no difference in heart events between the two.

The numbers and sources
Effect
In a pragmatic trial in adults 65 and older already on hydrochlorothiazide, a major cardiovascular event or non-cancer death occurred in 10.4% switched to chlorthalidone and 10.0% kept on hydrochlorothiazide over a median 2.4 years (HR 1.04, 95% CI 0.94 to 1.16) [7]. In a cohort of first-time users, the composite cardiovascular outcome did not differ (calibrated HR 1.00, 95% CI 0.85 to 1.17) [8]. Network meta-analyses that compared the drugs indirectly across separate trials found 21% fewer cardiovascular events on chlorthalidone (95% CI 12 to 28) [9], and 12% fewer on thiazide-like than thiazide-type diuretics after adjusting for blood pressure [10]. In 9 trials that compared them directly, chlorthalidone lowered systolic pressure by 3.26 mm Hg and diastolic by 2.41 mm Hg more [11].
Population
13,523 veterans with a mean age of 72 [7]; 730,225 first-time users in three US databases [8]; 9 trials with 50,946 people in the drug-adjusted analysis [9]; randomized trials of at least 1 year in adults with hypertension [10]; 9 head-to-head trials [11].
Sources
[7], [8], [9], [10], [11]
Caveats
In the head-to-head trial, 94.5% were taking hydrochlorothiazide 25 mg at entry and chlorthalidone was given at 12.5 or 25 mg [7]. The indirect comparisons do not randomize between the two drugs. For side effect differences, see the low potassium block below.
Moderate

Kidney stone prevention

Mixed results: a pooled analysis of 10 trials found 37% fewer stone recurrences on thiazides, and the largest trial found no difference from placebo.

The numbers and sources
Effect
A meta-analysis of 10 randomized trials found fewer stone recurrences on thiazides than placebo (RR 0.63, 95% CI 0.49 to 0.83), with substantial heterogeneity (I² 65%) [12]. In the largest trial, symptomatic or radiologic recurrence occurred in 59% on placebo and in 59%, 56% and 49% on hydrochlorothiazide 12.5, 25 and 50 mg, with no relation between dose and recurrence (P = 0.66) [13].
Population
650 people on thiazides and 672 on placebo in 10 trials [12]; 416 people with recurrent calcium-containing kidney stones followed a median 2.9 years [13].
Sources
[12], [13]
Caveats
The pooled trials are mostly older and smaller than [13]. Not an FDA-approved use [14].

Doses studied

The Cochrane review covered hydrochlorothiazide 6.25 to 50 mg a day and chlorthalidone 12.5 to 75 mg a day [1]. ALLHAT used chlorthalidone 12.5 to 25 mg a day [6]. The head-to-head trial compared hydrochlorothiazide 25 or 50 mg with chlorthalidone 12.5 or 25 mg a day [7]. The kidney stone trial used hydrochlorothiazide 12.5, 25 or 50 mg once daily [13], and the kidney disease trial used chlorthalidone from 12.5 mg up to 50 mg a day [3].

The chlorthalidone label gives a starting dose of 15 mg once daily for high blood pressure, raised to 25 mg if needed, and states that doses above 25 mg are not expected to lower blood pressure further [17].

Risks

Reported risks13

LimitedVery common

Erection problems

One trial found more erection problems on chlorthalidone than placebo over 2 years, 17.1% against 8.1%, with rates similar by 4 years.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
Among men in a double-blind trial of five blood pressure drugs, erection problems through 24 months were reported by 17.1% on chlorthalidone and 8.1% on placebo (P = 0.025). Through 48 months the rates were more similar across groups. Reported sexual problems in women were infrequent and did not differ by drug [24].
Population
557 men and 345 women aged 45 to 69 with mild hypertension, all given lifestyle counseling [24].
Sources
[24]
Caveats
One trial, of chlorthalidone. The abstract does not give the number of men in each group.
ModerateCommon

Low potassium

Shown to lower blood potassium, with low potassium in 6.0% on chlorthalidone and 4.4% on hydrochlorothiazide in a head-to-head trial.

The numbers and sources
How common
Common: between 1 in 100 and 1 in 10 people.
Effect
In the head-to-head trial, hypokalemia occurred in 6.0% on chlorthalidone and 4.4% on hydrochlorothiazide [7]. In a cohort of first-time users, hypokalemia was more frequent on chlorthalidone (HR 2.72, 95% CI 2.38 to 3.12) [8]. Across placebo-controlled trials, thiazides lowered potassium in a dose-related way, least with hydrochlorothiazide [1]. Hypokalemia was more frequent than on placebo in the kidney stone and kidney disease trials [13][3]. The hydrochlorothiazide label states that hypokalemia may cause cardiac arrhythmia and may heighten the heart's response to the toxic effects of digitalis [14].
Population
13,523 adults aged 65 and older [7]; 730,225 first-time users [8]; 11,282 people in 60 trials [1].
Sources
[7], [8], [1], [13], [3], [14]
Caveats
The two rates compare the drugs with each other. None of these abstracts gives a placebo rate.
ModerateCommon

Low sodium

Linked to low blood sodium in about 3.5% of new users over 2 years, about 1.4 percentage points more than on comparison drugs.

The numbers and sources
How common
Common: between 1 in 100 and 1 in 10 people.
Effect
In a Danish cohort, the 2-year cumulative incidence of sodium below 130 mmol/L was 3.51% in new users of hydrochlorothiazide combined with a renin-angiotensin drug, 1.38 percentage points more than on the renin-angiotensin drug alone (95% CI 1.01 to 1.75). For bendroflumethiazide it was 3.83%, 1.35 points more than on a calcium channel blocker. The excess was largest in the first 30 days (HR 4.25 and 3.56) and rose with age and illness [18]. In a US cohort, hyponatremia was more frequent on chlorthalidone than on hydrochlorothiazide (HR 1.31, 95% CI 1.16 to 1.47) [8].
Population
11,943 new users of hydrochlorothiazide with a renin-angiotensin drug and 85,784 of the renin-angiotensin drug alone, and 37,786 new users of bendroflumethiazide against 44,963 of a calcium channel blocker, all aged 40 or older [18]; 730,225 first-time users [8].
Sources
[18], [8]
Caveats
Observational. The authors note residual confounding is likely [18].
ModerateCommon

Higher blood sugar and new diabetes

Shown to bring more new diabetes than placebo or other blood pressure drugs, with placebo carrying about 23% lower odds than a diuretic.

The numbers and sources
How common
Common: between 1 in 100 and 1 in 10 people.
Effect
In a network meta-analysis of 22 trials with a diuretic as the reference, the odds of new diabetes were lower on placebo (OR 0.77, 95% CI 0.63 to 0.94), ARBs (0.57), ACE inhibitors (0.67) and calcium channel blockers (0.75), and not significantly different on beta-blockers (0.90). Diabetes developed in 998 of 18,699 people (5.34%) started on a diuretic [20]. In placebo-controlled trials, chlorthalidone raised serum glucose, and the evidence was unclear for other thiazides [1]. New diabetes was more frequent on chlorthalidone than hydrochlorothiazide in a cohort (HR 1.21, 95% CI 1.12 to 1.30) [8]. The label states that hyperglycemia may occur and latent diabetes may become manifest [14].
Population
143,153 people without diabetes at entry in 22 trials [20]; 11,282 people in 60 trials [1]; 730,225 first-time users [8].
Sources
[20], [1], [8], [14]
Caveats
The 5.34% is pooled across diuretic arms of different trials and is not directly comparable with the raw share in other arms. The odds ratios carry the comparison [20].
ModerateRare

Skin cancer with hydrochlorothiazide

Linked to more non-melanoma skin cancer, mainly squamous cell carcinoma, rising with cumulative dose. The label puts the excess at about 1 case per 16,000 people a year.

The numbers and sources
How common
Rare: fewer than 1 in 1,000 people.
Effect
In a Danish case-control study, cumulative use of 50,000 mg or more was associated with basal cell carcinoma (OR 1.29, 95% CI 1.23 to 1.35) and squamous cell carcinoma (OR 3.98, 95% CI 3.68 to 4.31), rising to 1.54 and 7.38 at 200,000 mg or more. Other diuretics and blood pressure drugs were not associated [21]. A meta-analysis found hydrochlorothiazide associated with non-melanoma skin cancer (OR 1.16, 95% CI 1.08 to 1.24), squamous cell carcinoma (OR 1.32) and melanoma (OR 1.11) [22]. A second, of 30 non-randomized studies of thiazides, found associations with squamous cell carcinoma (OR 1.35, 95% CI 1.22 to 1.48), basal cell carcinoma (OR 1.05), melanoma (OR 1.10) and lip cancer (OR 1.92) [23]. The label states that in an FDA Sentinel study the increased risk was mainly for squamous cell carcinoma and in white patients taking large cumulative doses: about 1 additional case per 16,000 patients a year overall, and 1 per 6,700 a year in white patients with 50,000 mg or more [14].
Population
Danish cancer registry cases from 2004 to 2012 with 20 matched controls each [21]; 17,848,313 participants in case-control and cohort studies [22]; 30 non-randomized studies [23].
Sources
[21], [22], [23], [14]
Caveats
All observational, with no data on sun exposure in the Danish study [21] and very low strength of evidence in one review [23]. No randomized trials were found. The finding is for hydrochlorothiazide, and chlorthalidone was not singled out in these sources.
LimitedRare

With NSAIDs

Linked to more acute kidney injury when an NSAID is taken with both a diuretic and an ACE inhibitor or ARB. The label says NSAIDs can blunt the diuretic.

The numbers and sources
How common
Rare: fewer than 1 in 1,000 people.
Effect
Among users of blood pressure drugs, an NSAID with both a diuretic and an ACE inhibitor or ARB was associated with a higher rate of acute kidney injury (rate ratio 1.31, 95% CI 1.12 to 1.53), highest in the first 30 days (1.82). An NSAID with a diuretic alone was not associated with a higher rate. Acute kidney injury occurred at 7 per 10,000 person-years in the cohort [26]. The hydrochlorothiazide label states that NSAIDs can reduce the diuretic and blood pressure effects of thiazides [14].
Population
487,372 users of blood pressure drugs in UK general practice, mean follow-up 5.9 years [26].
Sources
[26], [14]
Caveats
Observational. The study did not separate thiazides from other diuretics, and the rate is for the whole cohort [26].
ModerateHow often is not known

Gout and high uric acid

Linked to more than twice the risk of new gout with diuretic use in people with high blood pressure. Trials found thiazides raised uric acid.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
In a UK case-control study, current diuretic use was associated with incident gout among people with hypertension (RR 2.36, 95% CI 2.21 to 2.52) [19]. Across placebo-controlled trials, thiazides raised uric acid in a dose-related way [1]. Gout was more frequent on hydrochlorothiazide than placebo in the kidney stone trial [13]. The label states that hyperuricemia may occur and acute gout may be precipitated [14].
Population
24,768 people with new gout and 50,000 matched controls [19]; 11,282 people in 60 trials [1].
Sources
[19], [1], [13], [14]
Caveats
The case-control study grouped all diuretics together and gives no absolute rate [19].
LimitedHow often is not known

Kidney function changes

Limited evidence: creatinine rises were more frequent on thiazides than placebo in two trials, and kidney injury was more frequent on chlorthalidone than hydrochlorothiazide in one cohort.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
A creatinine level above 150% of baseline was more frequent on hydrochlorothiazide than placebo in the kidney stone trial [13], and reversible creatinine rises were more frequent on chlorthalidone than placebo in advanced kidney disease [3]. In a cohort of first-time users, acute kidney failure (HR 1.37, 95% CI 1.15 to 1.63) and chronic kidney disease (HR 1.24, 95% CI 1.09 to 1.42) were more frequent on chlorthalidone than hydrochlorothiazide [8].
Population
416 people with recurrent kidney stones [13]; 160 people with stage 4 chronic kidney disease [3]; 730,225 first-time users [8].
Sources
[13], [3], [8]
Caveats
None of the abstracts gives the rates.
LimitedHow often is not known

Sudden eye pain and blurred vision

The label warns that hydrochlorothiazide can cause sudden nearsightedness and acute angle-closure glaucoma, usually within hours to weeks of starting. It gives no rate.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
The label states that hydrochlorothiazide, a sulfonamide, can cause an idiosyncratic reaction resulting in acute transient myopia and acute angle-closure glaucoma, with sudden loss of visual sharpness or eye pain, typically within hours to weeks of starting [14].
Population
People taking hydrochlorothiazide, as described in the label [14].
Sources
[14]
Caveats
No rate or comparison group is given.
LimitedHow often is not known

With diabetes medication

The label warns that thiazides can raise blood sugar, so the dose of insulin or oral diabetes drugs may need adjusting. It gives no rate.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
The hydrochlorothiazide label lists insulin and oral diabetes drugs among interacting medicines and states that their dose may need adjustment, because hyperglycemia may occur with thiazides [14].
Population
People with diabetes taking hydrochlorothiazide, as described in the label [14].
Sources
[14]
Caveats
The label gives no rate. For trial evidence on blood sugar, see the block above.
LimitedHow often is not known

With other blood pressure drugs, opioids, sedatives or alcohol

The label warns of an added blood pressure effect with other blood pressure drugs, and of dizziness on standing with alcohol, barbiturates or narcotics.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
The hydrochlorothiazide label states that other antihypertensive drugs have an additive effect, and that alcohol, barbiturates or narcotics may worsen low blood pressure on standing [14].
Population
People taking hydrochlorothiazide with these drugs, as described in the label [14].
Sources
[14]
Caveats
The label gives no rate.
LimitedHow often is not known

With corticosteroids or digoxin

The label warns that corticosteroids deepen potassium loss on a thiazide, and that low potassium heightens the heart's sensitivity to digitalis.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
The hydrochlorothiazide label states that corticosteroids and ACTH intensify electrolyte depletion, particularly hypokalemia, and that hypokalemia may sensitize or exaggerate the response of the heart to the toxic effects of digitalis [14].
Population
People taking hydrochlorothiazide with these drugs, as described in the label [14].
Sources
[14]
Caveats
The label gives no rate.
LimitedHow often is not known

Use in pregnancy

The label states that routine use of diuretics in a normal pregnancy exposes mother and fetus to unnecessary hazard. It gives no rate.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
The hydrochlorothiazide label states that routine use of diuretics during normal pregnancy is inappropriate and exposes mother and fetus to unnecessary hazard, that diuretics do not prevent toxemia of pregnancy, and that thiazides are indicated in pregnancy when edema has a pathologic cause [14].
Population
Pregnant women, as described in the label [14].
Sources
[14]
Caveats
The label cites no study and gives no rate.

Mixed results1

LimitedHow often is not known

With lithium

Mixed results: the label warns that diuretics reduce lithium clearance and raise toxicity risk, and one cohort did not find more toxicity admissions with thiazides.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
The hydrochlorothiazide label states that diuretics reduce the kidney's clearance of lithium and add a high risk of lithium toxicity [14]. In a study of older adults on lithium, thiazide diuretics were not independently associated with a significant rise in hospital admission for lithium toxicity, while loop diuretics (RR 5.5) and ACE inhibitors (RR 7.6) were [25].
Population
10,615 Ontario residents aged 66 and older on lithium [25].
Sources
[14], [25]
Caveats
One observational study, in older adults, counting only hospital admissions.

Claims tested and not found

  1. That chlorthalidone prevents more heart attacks and strokes than hydrochlorothiazide. In 13,523 adults aged 65 and older, a major cardiovascular event or non-cancer death occurred in 10.4% on chlorthalidone and 10.0% on hydrochlorothiazide (HR 1.04, 95% CI 0.94 to 1.16) [7].
  2. That hydrochlorothiazide prevents kidney stones from coming back. In 416 people with recurrent calcium stones, recurrence at 12.5, 25 and 50 mg did not differ from placebo, and there was no dose-response [13].
  3. That people allergic to sulfa antibiotics react to non-antibiotic sulfa drugs, the group hydrochlorothiazide belongs to, because the drugs cross-react. Among people with a prior reaction to a sulfonamide antibiotic, 9.9% reacted to a sulfonamide nonantibiotic against 1.6% of those without (adjusted OR 2.8). The same people were even more likely to react to penicillin (adjusted OR 3.9), and the authors reported an absence of cross-reactivity between the two sulfonamide groups [27].
  4. That higher chlorthalidone doses lower blood pressure more. Across trials of 12.5 to 75 mg a day, direct comparison of doses showed no dose dependence for blood pressure lowering [1].

Sources

  1. Musini VM, Nazer M, Bassett K, Wright JM. Blood pressure-lowering efficacy of monotherapy with thiazide diuretics for primary hypertension. Cochrane Database of Systematic Reviews. 2014. https://doi.org/10.1002/14651858.CD003824.pub2
  2. Law MR, Wald NJ, Morris JK, Jordan RE. Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trials. BMJ. 2003. https://doi.org/10.1136/bmj.326.7404.1427
  3. Agarwal R, Sinha AD, Cramer AE, et al. Chlorthalidone for Hypertension in Advanced Chronic Kidney Disease. New England Journal of Medicine. 2021. https://doi.org/10.1056/NEJMoa2110730
  4. Wright JM, Musini VM, Gill R. First-line drugs for hypertension. Cochrane Database of Systematic Reviews. 2018. https://doi.org/10.1002/14651858.CD001841.pub3
  5. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA. 1991. https://doi.org/10.1001/jama.1991.03460240051027
  6. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002. https://doi.org/10.1001/jama.288.23.2981
  7. Ishani A, Cushman WC, Leatherman SM, et al. Chlorthalidone vs. Hydrochlorothiazide for Hypertension-Cardiovascular Events. New England Journal of Medicine. 2022. https://doi.org/10.1056/NEJMoa2212270
  8. Hripcsak G, Suchard MA, Shea S, et al. Comparison of Cardiovascular and Safety Outcomes of Chlorthalidone vs Hydrochlorothiazide to Treat Hypertension. JAMA Internal Medicine. 2020. https://doi.org/10.1001/jamainternmed.2019.7454
  9. Roush GC, Holford TR, Guddati AK. Chlorthalidone compared with hydrochlorothiazide in reducing cardiovascular events: systematic review and network meta-analyses. Hypertension. 2012. https://doi.org/10.1161/HYPERTENSIONAHA.112.191106
  10. Olde Engberink RH, Frenkel WJ, van den Bogaard B, et al. Effects of thiazide-type and thiazide-like diuretics on cardiovascular events and mortality: systematic review and meta-analysis. Hypertension. 2015. https://doi.org/10.1161/HYPERTENSIONAHA.114.05122
  11. Dineva S, Uzunova K, Pavlova V, et al. Comparative efficacy and safety of chlorthalidone and hydrochlorothiazide-meta-analysis. Journal of Human Hypertension. 2019. https://doi.org/10.1038/s41371-019-0255-2
  12. Porto BC, Terada BD, Gonçalves FG, et al. Thiazide diuretics for preventing calcium oxalate recurrent kidney stones: an updated systematic review, meta-analysis and trial sequential analysis of randomized controlled trials. Minerva Urology and Nephrology. 2025. https://doi.org/10.23736/S2724-6051.25.05903-8
  13. Dhayat NA, Bonny O, Roth B, et al. Hydrochlorothiazide and Prevention of Kidney-Stone Recurrence. New England Journal of Medicine. 2023. https://doi.org/10.1056/NEJMoa2209275
  14. Hydrochlorothiazide tablets (Chartwell), prescribing information. DailyMed, US National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=4e43dd27-3f4b-4205-a26e-6ecaa8281347
  15. Xiao X, Xu Y, Wu Q. Thiazide diuretic usage and risk of fracture: a meta-analysis of cohort studies. Osteoporosis International. 2018. https://doi.org/10.1007/s00198-018-4486-9
  16. Puttnam R, Davis BR, Pressel SL, et al. Association of 3 Different Antihypertensive Medications With Hip and Pelvic Fracture Risk in Older Adults: Secondary Analysis of a Randomized Clinical Trial. JAMA Internal Medicine. 2017. https://doi.org/10.1001/jamainternmed.2016.6821
  17. Thalitone (chlorthalidone) tablets, prescribing information. DailyMed, US National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=bc5a0299-115b-4e60-bb3f-c75a95c51c15
  18. Andersson NW, Wohlfahrt J, Feenstra B, Hviid A, Melbye M, Lund M. Cumulative Incidence of Thiazide-Induced Hyponatremia: A Population-Based Cohort Study. Annals of Internal Medicine. 2024. https://doi.org/10.7326/M23-1989
  19. Choi HK, Soriano LC, Zhang Y, Rodríguez LA. Antihypertensive drugs and risk of incident gout among patients with hypertension: population based case-control study. BMJ. 2012. https://doi.org/10.1136/bmj.d8190
  20. Elliott WJ, Meyer PM. Incident diabetes in clinical trials of antihypertensive drugs: a network meta-analysis. The Lancet. 2007. https://doi.org/10.1016/S0140-6736(07)60108-1
  21. Pedersen SA, Gaist D, Schmidt SAJ, et al. Hydrochlorothiazide use and risk of nonmelanoma skin cancer: A nationwide case-control study from Denmark. Journal of the American Academy of Dermatology. 2018. https://doi.org/10.1016/j.jaad.2017.11.042
  22. Shao SC, Lai CC, Chen YH, et al. Associations of thiazide use with skin cancers: a systematic review and meta-analysis. BMC Medicine. 2022. https://doi.org/10.1186/s12916-022-02419-9
  23. Nochaiwong S, Chuamanochan M, Ruengorn C, et al. Use of Thiazide Diuretics and Risk of All Types of Skin Cancers: An Updated Systematic Review and Meta-Analysis. Cancers. 2022. https://doi.org/10.3390/cancers14102566
  24. Grimm RH, Grandits GA, Prineas RJ, et al. Long-term effects on sexual function of five antihypertensive drugs and nutritional hygienic treatment in hypertensive men and women. Treatment of Mild Hypertension Study (TOMHS). Hypertension. 1997. https://doi.org/10.1161/01.HYP.29.1.8
  25. Juurlink DN, Mamdani MM, Kopp A, et al. Drug-induced lithium toxicity in the elderly: a population-based study. Journal of the American Geriatrics Society. 2004. https://doi.org/10.1111/j.1532-5415.2004.52221.x
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