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Editorial |

Diuretics Are Color Blind

James D. Neaton, PhD; Lewis H. Kuller, MD
JAMA. 2005;293(13):1663-1666. doi:10.1001/jama.293.13.1663.
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The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) is considered one of the most important recent clinical trials in hypertension. This mega-trial was motivated by (1) the observation that trials of participants with diastolic blood pressure (BP) in the range of 90 to 114 mm Hg did not result in as large a reduction in coronary heart disease (CHD) incidence as the epidemiologic data suggested should be the case; (2) different classes of antihypertensive drugs were thought to have fewer adverse effects (eg, decreased levels of serum potassium, increased levels of blood glucose and blood cholesterol and triglycerides) than diuretics, and these adverse effects might explain the lower than expected effect on CHD of a diuretic-based BP-lowering treatment; and (3) newer agents that had potentially favorable mechanisms of action might provide benefit above and beyond BP control.1,2 The high prevalence of hypertension in the United States3 and the consequent significance of even moderately reducing the incidence of clinical outcomes through an improved understanding of treatment make studies such as ALLHAT a public health imperative.

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