Our paper on comparative effectiveness of thiazide diuretics for #hypertension. Similar effectiveness. Hydrochlorothiazide safer. Observational study with remarkably strong methods, large sample. jamanetwork.com/journals/jamai… @OHDSI @suchard_group
@OHDSI @suchard_group I was fortunate to work with an incredibly talented group, committed to answering important questions w/exemplary methods - and pre-specifying our approach and sharing code. Fantastic example of open science team. Sure, we want trial evidence, but in the meantime...
@OHDSI @suchard_group And data from high quality observational studies have a place, but quality of data and methods matter. Trials cannot address every question in every population. These data can complement trial data. And in the absence of trial data, are the best we have. But has to be done well.
@OHDSI @suchard_group And this study has relevance to everyday practice, we should not assume all drugs in a class act the same. We need more head to head comparisons. Not true they are similar till proven so. @PCORI: a nice avenue for funding...
@OHDSI @suchard_group @PCORI We concluded: 'chlorthalidone use was not associated with significant cardiovascular benefits when compared with hydrochlorothiazide, while its use was associated with greater risk of renal and electrolyte abnormalities.’ @JAMAInternalMed
Our study was based on 14 104 individuals receiving chlorthalidone and 287 390 individuals receiving hydrochlorothiazide. Just because it is big doesn’t mean it is a good study… but size helps when accompanied by high quality methods.
What are good methods? 'Balancing of large numbers of baseline patient covariates to make comparison groups more equivalent, using many negative controls to detect and correct residual bias and testing of the consistency among heterogeneous data sources.’ @OHDSI
@OHDSI So until better evidence says otherwise (and we always hope for better evidence), I will be recommending hydrochlorothiazide for those using a thiazide diuretic for hypertension. This is a change for me.
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