Chlorthalidone is preferred over hydrochlorothiazide for hypertension management in major trials such as ALLHAT and SPRINT-influenced guidelines. What pharmacological property accounts for its superior cardiovascular protection?

• A Suppression of renin secretion from the juxtaglomerular apparatus
• B Potassium-sparing action through ENaC inhibition
• C Vascular smooth muscle relaxation via calcium channel blockade
• D Greater potency and longer half-life providing sustained 24-hour BP control ✓

Explanation

Chlorthalidone is approximately 1.5 to 2 times more potent than hydrochlorothiazide and has a longer half-life (40-60 hours versus 6-12 hours), providing sustained blood pressure reduction. It also has greater reductions in cardiovascular events in comparative data. It does not have ENaC-blocking or direct vasodilatory properties. Both thiazides can raise renin.

Reference: Kaplan's Clinical Hypertension, 11th ed.

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