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To the Editor: During the course of the ALLHAT study,¹ about 10% of all patients developed new diabetes, defined as a fasting blood sugar greater than 126 mg/dL. Interestingly, the risk among patients on chlorthalidone was between 43% to 65% higher vs those on lisinopril and between 18% to 30% higher vs those on amlodipine.

These findings corroborate previous findings of a moderate risk of diabetes with thiazide diuretics^2-3 and of an equally moderate protective effect of drugs that block the renin-angiotensin system.^4-5 However, the ALLHAT authors state, "Overall these metabolic differences did not translate into more cardiovascular events or into higher all-cause mortality in the chlorthalidone group compared with the other 2 groups." Although it may seem reassuring that none of the complications of diabetes was observed in ALLHAT, it must be remembered that antihypertensive therapy is lifelong, and that, therefore, a period of 2 to 6 years, such . . . [Full Text of this Article]

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