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Letters
September 10, 2003

The JNC 7 Hypertension Guidelines—Reply

JAMA. 2003;290(10):1312. doi:10.1001/jama.290.10.1312-a

To the Editor: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) recommends that thiazide-type diuretics should be prescribed as initial therapy for most patients with hypertension.1 Although an extensive meta-analysis also concluded that diuretics are the most effective treatment for preventing morbidity and mortality in patients with hypertension,2 the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)3 found that patients receiving diuretic therapy had a higher incidence of hypokalemia, hyperglycemia, new-onset diabetes, and a more rapid decline in glomerular filtration rate compared with those receiving amlodipine or lisinopril. Furthermore, diuretic-induced hyponatremia is not always a benign condition.4

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