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Ajay K. Gupta, MD, MSc; Neil R. Poulter, MD, MSc, FRCP

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The study by Barzilay et al¹ reconfirms that thiazide-like diuretics are associated with an increased risk of new-onset diabetes compared with other antihypertensive agents and that incident diabetes is associated with increased risk of all cardiovascular events and significantly so for coronary heart disease. However the authors of these analyses suggest that diuretic-associated incident diabetes may be "innocent." If true, this would be a surprising observation with important clinical implications and therefore merits careful examination.

As the authors point out, this is a post hoc analysis of nonrandomized data with only 53% of the eligible "nondiabetic" patients having 1 or more measurement of fasting glucose. Those excluded were biased toward blacks and women who are more prone to diabetes and/or risk of diabetes-related cardiovascular outcomes, respectively. The definition of incident diabetes used (a single measurement of fasting glucose > 125 . . . [Full Text of this Article]

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