The day a physician loses his humility is the day that physician becomes a menace to society.—Richard Gorlin, MD
The primary outcome analysis of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)1 demonstrated that first-step therapy with a thiazide diuretic was equally effective in reducing major cardiovascular events compared with either a calcium channel blocker (CCB) or angiotensin-converting enzyme (ACE) inhibitor. The results did not bring joy to the pharmaceutical industry, academicians with excessively close ties to the industry, or hypertension specialists wedded to the importance of renin-angiotensin system blockade. The report from the ALLHAT trial in this issue of the ARCHIVES2 will not bring solace to any of these groups. In this retrospective analysis, ALLHAT investigators demonstrate that patients with hypertension who develop diabetes mellitus (DM) while taking thiazide fare better than those who develop DM undergoing treatment with a CCB or ACE inhibitor. The findings of this report make it hard for practitioners and policy makers to shy away from diuretics as first-line therapy for hypertension.
Phillips RA. New-Onset Diabetes Mellitus Less Deadly Than Elevated Blood Pressure? Following the Evidence in the Administration of Thiazide Diuretics. Arch Intern Med. 2006;166(20):2174–2176. doi:10.1001/archinte.166.20.2174
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