0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editor's Correspondence |

ALLHAT Debate: Diuretics Are Not Preferred, First-Line Initial Therapy for Hypertension

Mark C. Houston
Arch Intern Med. 2004;164(5):570-571. doi:10.1001/archinte.164.5.570-b.
Text Size: A A A
Published online

Extract

In a recent Commentary in the ARCHIVES, Dr Moser1 has erroneously concluded that thiazide diuretics are the "gold standard" of hypertensive therapy and that they do not cause "metabolic abnormalities" such as dyslipidemia, hyperglycemia, new-onset diabetes, hypokalemia, or renal insufficiency. His conclusions are based on inherent design flaws and subsequent inaccurate data from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), as well as a selected bias toward older studies, while ignoring recent clinical trials and even the reported diuretic-induced metabolic issues from ALLHAT. The Systolic Hypertension in the Elderly Program (SHEP) study2 found no reduction in any cardiovascular events at 1 year in the 7.2% of subjects with hypokalemia (serum potassium level <3.5 mmol/L) treated with low-dose chlorthalidone at 25 mg/d. The Antihypertensive Treatment and Lipid Profile in a North of Sweden Efficacy Evaluation (ALPINE) study3 confirms the metabolic dysfunction induced by thiazide diuretics alone or in combination with a β-blocker. The diuretic–β-blocker combination therapy compared with a calcium channel blocker–angtiotensin receptor blocker combination therapy resulted in a significantly greater incidence of insulin resistance, hyperglycemia, new-onset diabetes mellitus, dyslipidemia, metabolic syndrome, hypokalemia, hyperuricemia, and increased serum creatinine level at 1 year in a group of previously untreated hypertensive subjects.3 Other prospective clinical trials47 and epidemiological studies8 have demonstrated more hyperglycemia and new-onset diabetes mellitus with use of diuretics4 and β-blockers5 compared with angiotensin-converting enzyme inhibitor,4,6 angiotensin receptor blocker,5 or calcium channel blocker4 use, as well as more renal insufficiency.79 Finally, thiazide diuretics increase homocysteine levels (≥16%), which may blunt their cardiovascular protection in coronary heart disease and stroke symdrome.9

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 8

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
JAMAevidence.com
brightcove.createExperiences();