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Metabolic issues in the Antihypertensive and Lipid-Lowering Heart Attack Trial Study

Henry A Punzi1, Connie F Punzi,

  • 1Punzi Medical Center, 1932 Walnut Plaza, Carrollton, TX 75006, USA. punzimedcenter@aol.com

Current Hypertension Reports
|March 11, 2004
PubMed

Insights

Thiazide-type diuretics are recommended for hypertension but increase diabetes risk. The ALLHAT trial showed higher diabetes incidence with chlorthalidone, a risk potentially underestimated by JNC-7 guidelines.

Area of Science:

  • Cardiology
  • Pharmacology
  • Endocrinology

Background:

  • The Seventh Joint National Committee (JNC-7) recommends thiazide-type diuretics as initial hypertension therapy based on the ALLHAT trial.
  • The ALLHAT trial found no significant difference in primary cardiovascular outcomes between treatment groups.

Purpose of the Study:

  • To evaluate the JNC-7 recommendation for thiazide-type diuretics in hypertension management.
  • To critically assess the risk of new-onset diabetes associated with thiazide-type diuretics.

Main Methods:

  • Analysis of data from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack (ALLHAT) Trial.
  • Comparison of new-onset diabetes incidence across different antihypertensive drug classes.

Main Results:

  • Thiazide-type diuretics, specifically chlorthalidone, were associated with a 43% to 65% higher risk of new-onset diabetes compared to amlodipine and lisinopril.
  • Despite increased diabetes risk, the ALLHAT study did not observe a corresponding increase in cardiovascular events within its 2- to 6-year timeframe.

Conclusions:

  • The JNC-7's strong endorsement of thiazide-type diuretics may lead to an increased incidence of diabetes.
  • The long-term morbidity and mortality implications of diabetes, which manifest over decades, are not fully captured by the short-term follow-up in the ALLHAT study.

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