EBMtrialcentral- Comparing Initial Diuretic Therapies Using a Collaborative Network

\- BACKGROUND: The application of many traditional randomized controlled trial(RCT) findings to real-world practice is in question. To this end, comparative effectiveness research(CER) has evolved. However, there remains ample evidence that U.S. trials are becoming increasingly cumbersome and expensive. Moreover, 90 percent fail to meet enrollment goals. In contrast, there have been significant recent technological advances in both bioinformatics and social media. However, thus-far, the combined potential of both has yet to be achieved in the field of medicine. The stage is now set for an amalgamation of these three disciplines; CER, bioinformatics and social media. EBMtrialcentral is a non-profit website developed at Johns Hopkins University with the idea of using an online social network to actually perform CER trials. By harnessing the power of social media, EBMtrialcentral could open up a world of opportunity for conducting clinical research and bring randomization into "usual care". * OBJECTIVES: 1. To determine if a social network website can be created, among a group of academic physicians, with the pre-specified objective of using this website to conduct a CER trial. 2. To perform a pilot-study though the website. This study will randomly allocate initial anti-hypertensive treatment strategies, using guideline recommended diuretic agents. * METHODS: 1. Website development-A test website, EBMtrialcentral.org, has been initiated. By visiting the website, eligible physicians will be able to join the collaborative network. Once a member physician identifies an eligible patient who agrees to participate, consent forms will be generated online for formal enrollment. A therapeutic strategy will be randomly allocated via the website. The investigators' platform would require parsimonious imputation of secured patient data. Follow-up will be pragmatic and guideline-directed. Data will initially be managed in a protected online database run by "project REDCap". Patients and patient advocate stakeholders will be invited to help with IRB and website development. 2. Pilot study-Despite stronger evidence for chlorthalidone, most hypertensive patients prescribed diuretics currently receive HCTZ. However, the two have not been randomly compared in an adequately powered study. The investigators will require 80 newly hypertensive urban subjects to detect a greater than 5mmHg mean automated BP difference between the two groups over 2 monthly follow-up visits (8 weeks total, with a standardized effect size of 0.7 based on prior data). The investigators will include ethnic and under-served subjects. Exclusion criteria will include compelling indications for alternative anti-hypertensives. Non-blinded random allocation will be generated online.