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September 10, 2003

The JNC 7 Hypertension Guidelines

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

In Reply: In response to Dr Ong, in several long-term controlled clinical trials (eg, ALLHAT and Hypertension Detection and Follow-up Program [HDFP]),1,2 the metabolic changes associated with diuretic therapy were relatively minor and did not translate into increased incidence of cardiovascular events. Slight increases in blood glucose levels and incidence of diabetes were observed but the benefits of diuretic therapy in such patients outweighed the potential negative effects of such changes. Periodic monitoring of blood chemistries is advisable in all patients with hypertension, not just those on diuretic therapy, and any abnormalities would need to be managed appropriately. However, although it is possible that future studies of diuretic use of more than 5 years duration might yield data that differ from those reported in the ALLHAT and HDFP studies, we believe that the available data justify the use of diuretics in patients with hypertension and diabetes.