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(Hypertension. 2008;52:30.)
© 2008 American Heart Association, Inc.

Brief Reviews

Thiazide-Induced Dysglycemia

Call for Research From a Working Group From the National Heart, Lung, and Blood Institute

Barry L. Carter; Paula T. Einhorn; Michael Brands; Jiang He; Jeffrey A. Cutler; Paul K. Whelton; George L. Bakris; Frederick L. Brancati; William C. Cushman; Suzanne Oparil; Jackson T. Wright, Jr

From the Division of Clinical and Administrative Pharmacy (B.L.C.), College of Pharmacy and Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa; Division of Prevention and Population Sciences (P.T.E., J.A.C.), National Heart, Lung, and Blood Institute, Bethesda, Md; Department of Physiology (M.B.), Medical College of Georgia, Augusta; Department of Epidemiology (J.H.), Tulane University School of Public Health and Tropical Medicine, New Orleans, La; Loyola University Medical Center (P.K.W.), Chicago, Ill; Hypertensive Diseases Unit (G.L.B.), University of Chicago, Ill; Departments of Medicine and Epidemiology (F.L.B.), Johns Hopkins University, Baltimore, Md; Memphis Veterans’ Affairs Medical Center and Department of Preventive Medicine and Medicine (W.C.C.), University of Tennessee College of Medicine, Memphis; Division of Cardiovascular Diseases (S.O.), Department of Medicine, Physiology, and Biophysics, University of Alabama at Birmingham; and the Department of Medicine (J.T.W.), Case Western Reserve University, Cleveland, Ohio.

Correspondence to Barry L. Carter, Division of Clinical and Administrative Pharmacy, Rm 527, College of Pharmacy, University of Iowa, Iowa City, IA 52242. E-mail barry.carter@uiowa.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
There are >70-million hypertensive individuals in the United States, and >45-million persons take antihypertensive medications.^1,2 Despite the results of the Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT), other trials, and the recommendations in the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, well under 50% of these regimens include a thiazide-type diuretic.^2,3 In the Department of Veterans’ Affairs, which participated in several of the studies supporting the use of thiazide diuretics, 35% of hypertensive patients on pharmacotherapy had a thiazide diuretic included in their hypertension treatment regimens in 2003.⁴ In private patient encounters, thiazide diuretic use rose from 19% of all of the antihypertensive patient visits in 2002 to 26% in 2004.⁵

The recommendations for preferred use of thiazide-type diuretics are based on >4 decades of clinical trials, including active-controlled trials, where diuretics were tested against other drugs for their efficacy in preventing hard clinical outcomes, such as myocardial infarction, death, stroke, heart failure, and renal failure. ALLHAT, a randomized, double-blind, active-controlled antihypertensive treatment trial in 42 418 patients assigned to a thiazide-type diuretic, an angiotensin-converting enzyme (ACE) inhibitor, a calcium channel-blocker, (average follow-up: 4.9 years), or the doxazosin/chlorthalidone comparison (terminated early, average follow-up: 3.2 years) showed that the diuretic was at least as beneficial as the comparator drugs in lowering blood pressure (BP) and preventing cardiovascular (CV) and renal outcomes and was superior for preventing heart failure (versus each comparator arm), combined CV events (versus -blocker and . . . [Full Text of this Article]

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