{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T14:34:39Z","timestamp":1781706879533,"version":"3.54.5"},"reference-count":17,"publisher":"Oxford University Press (OUP)","issue":"5","funder":[{"DOI":"10.13039\/100000050","name":"National Heart Lung & Blood Institute","doi-asserted-by":"publisher","award":["R01\u00a0HL126903"],"award-info":[{"award-number":["R01\u00a0HL126903"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,5,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:p>Treatment-resistant hypertension is common among patients with advanced chronic kidney disease (CKD). In people with preserved kidney function, spironolactone is an evidence-based treatment. However, the risk for hyperkalemia limits its use in people with more advanced CKD. In the Chlorthalidone in Chronic Kidney Disease (CLICK) trial, 160 patients with stage 4 CKD and poorly controlled hypertension as confirmed by 24-hour ambulatory blood pressure (ABP) monitoring were randomly assigned to either placebo or chlorthalidone 12.5\u00a0mg daily in a 1:1 ratio stratified by prior loop diuretic use. The primary endpoint was the change in 24-hour systolic ABP from baseline to 12 weeks. The trial showed a treatment-induced reduction of 24-hour systolic ABP by 10.5\u00a0mmHg. Of the 160 patients randomized, 113 (71%) had resistant hypertension, of which 90 (80%) were on loop diuretics and the mean number of antihypertensive medications prescribed was 4.1 (standard deviation 1.1). In this subgroup of patients with treatment-resistant hypertension, the adjusted change from baseline to 12\u00a0weeks in the between-group difference in 24-hour systolic ABP was \u221213.9\u00a0mmHg (95% CI \u221219.4 to \u22128.4; P\u00a0&amp;lt;\u00a0.0001). Furthermore, compared with placebo, the urine albumin:creatinine ratio in the chlorthalidone group at 12\u00a0weeks was 54% lower (95% CI \u221265 to \u221240). Following randomization, hypokalemia, reversible increases in serum creatinine, hyperglycemia, dizziness, orthostatic hypotension and hyperuricemia occurred more frequently in the chlorthalidone group. Chlorthalidone has the potential to improve BP control among patients with advanced CKD and treatment-resistant hypertension. However, caution is advised when treating patients, especially when they are on loop diuretics.<\/jats:p>","DOI":"10.1093\/ckj\/sfac272","type":"journal-article","created":{"date-parts":[[2022,12,17]],"date-time":"2022-12-17T00:05:10Z","timestamp":1671235510000},"page":"793-796","source":"Crossref","is-referenced-by-count":3,"title":["Should we CLICK on chlorthalidone for treatment-resistant hypertension in chronic kidney disease?"],"prefix":"10.1093","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8355-7100","authenticated-orcid":false,"given":"Rajiv","family":"Agarwal","sequence":"first","affiliation":[{"name":"Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center Division of Nephrology, , Indianapolis , IN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,12,20]]},"reference":[{"key":"2024030112380926800_bib1","first-page":"e13","article-title":"2017 ACC\/AHA\/AAPA\/ABC\/ACPM\/AGS\/APhA\/ASH\/ASPC\/NMA\/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: a Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines","volume":"71","author":"Whelton","year":"2018","journal-title":"Hypertension"},{"key":"2024030112380926800_bib2","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1161\/HYPERTENSIONAHA.108.189141","article-title":"Resistant hypertension: diagnosis, evaluation, and treatment. 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