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Results from the largest antihypertensive trial to date — ALLHAT — suggested that diuretics should be the preferred initial drug for treating patients with hypertension. However, concern persists about thiazides because of their adverse effects on insulin sensitivity and onset of diabetes, particularly among people with diabetes risk factors. In a post hoc analysis, ALLHAT researchers assessed metabolic and cardiovascular outcomes in nondiabetic patients with or without metabolic syndrome who were assigned to a diuretic (chlorthalidone), a calcium-channel blocker (CCB; amlodipine), or an angiotensin-converting–enzyme (ACE) inhibitor (lisinopril).
Among people with metabolic syndrome, diabetes incidence at 4 years was 17% in the chlorthalidon…