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In a recent Commentary in the ARCHIVES, Dr Moser¹ has erroneously concluded that thiazide diuretics are the "gold standard" of hypertensive therapy and that they do not cause "metabolic abnormalities" such as dyslipidemia, hyperglycemia, new-onset diabetes, hypokalemia, or renal insufficiency. His conclusions are based on inherent design flaws and subsequent inaccurate data from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), as well as a selected bias toward older studies, while ignoring recent clinical trials and even the reported diuretic-induced metabolic issues from ALLHAT. The Systolic Hypertension in the Elderly Program (SHEP) study² found no reduction in any cardiovascular events at 1 year in the 7.2% of subjects with hypokalemia (serum potassium level <3.5 mmol/L) treated with low-dose chlorthalidone at 25 mg/d. The Antihypertensive Treatment and Lipid Profile in a North of Sweden Efficacy Evaluation (ALPINE) study³ confirms the metabolic dysfunction induced by thiazide diuretics alone or . . . [Full Text of this Article]

Mark C. Houston, MD
Nashville, Tenn

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