A new paper from University Texas states “chlorthalidone, the first-line drug therapy for hypertension”. They then show that it “causes persistent activation of sympathetic nervous system and insulin resistance in hypertensive patients. These side effects, however, are avoided by spironolactone despite similar reduction in BP.”
But there is no evidence exept in the manufacturers’ mind to claim that chlorthalidone is the first-line drug therapy for hypertension. Chlorthalidone is simply another thiazide- which all share the same problems. But hydrochlorothiazide has no effect on the autonomic nervous system.. Nor does amiloride in sensible real life use.
However, the gold standard of initial therapy for most cases of hypertension remains the triple combination (at US$6/year) of lowdose co-amilothiazide (amiloretic) eg 6.5 to 13mg/day (or 3 times a week) plus lowdose reserpine 1/4 to 1/2 a day (or 3 x a week) – which combination -especially with fish oil and multinutrient (vits A-K, zinc, magnesium, arginine, carnitine, CoQ10 etc) for multisystem benefits- has no adverse effects while reversing essential hypertension and other cardiovascular risks in all but the most advanced cases.
This avoids the major disadvantage of gynecomastia from spironolactone – which even at 50 mg/d caused gynecomastia in 6.9% , ie there is still potent antiandrogenic effect at low dose, which is bad for both genders in a world already heavily polluted by xenoestrogenics.