Chlorthalidone yielded a higher rate of newly diagnosed diabetes than lisinopril (17.1% vs 12.6%, P<0.05) but was superior for preventing heart failure and CVD in patients with metabolic syndrome.
RCT
Randomly assigned (inferred from ALLHAT parent trial)
Does chlorthalidone compared to amlodipine or lisinopril improve cardiovascular outcomes in nondiabetic hypertensive adults with metabolic syndrome?
Thiazide-like diuretics offer similar or superior cardiovascular outcomes compared to CCBs and ACE inhibitors in older hypertensive adults with metabolic syndrome, despite a less favorable metabolic profile.
Absolute Event Rate: 17.1% vs 12.6%
p-value: p=<0.05
OBJECTIVE: Optimal initial antihypertensive drug therapy in people with the metabolic syndrome is unknown. RESEARCH DESIGN AND METHODS: We conducted a subgroup analysis of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) to compare metabolic, cardiovascular, and renal outcomes in individuals assigned to initial hypertension treatment with a thiazide-like diuretic (chlorthalidone), a calcium channel blocker (CCB; amlodipine), or an ACE inhibitor (lisinopril) in nondiabetic individuals with or without metabolic syndrome. RESULTS: In participants with metabolic syndrome, at 4 years of follow-up, the incidence of newly diagnosed diabetes (fasting glucose >or=126 mg/dl) was 17.1% for chlorthalidone, 16.0% for amlodipine (P = 0.49, chlorthalidone vs. amlodipine) and 12.6% for lisinopril (P < 0.05, lisinopril vs. chlorthalidone). For those without metabolic syndrome, the rate of newly diagnosed diabetes was 7.7% for chlorthalidone, 4.2% for amlodipine, and 4.7% for lisinopril (P < 0.05 for both comparisons). There were no differences in relative risks (RRs) for outcomes with amlodipine compared with chlorthalidone in those with metabolic syndrome; in those without metabolic syndrome, there was a higher risk for heart failure (RR 1.55 95% CI 1.25-1.35). In comparison with lisinopril, chlorthalidone was superior in those with metabolic syndrome with respect to heart failure (1.31 1.04-1.64) and combined cardiovascular disease (CVD) (1.19 1.07-1.32). No significant treatment group-metabolic syndrome interaction was noted. CONCLUSIONS: Despite a less favorable metabolic profile, thiazide-like diuretic initial therapy for hypertension offers similar, and in some instances possibly superior, CVD outcomes in older hypertensive adults with metabolic syndrome, as compared with treatment with CCBs and ACE inhibitors.
Black et al. (Mon,) conducted a rct in Hypertension in nondiabetic individuals with or without metabolic syndrome. Chlorthalidone vs. Amlodipine or Lisinopril was evaluated on Newly diagnosed diabetes in participants with metabolic syndrome (p=<0.05). Chlorthalidone yielded a higher rate of newly diagnosed diabetes than lisinopril (17.1% vs 12.6%, P<0.05) but was superior for preventing heart failure and CVD in patients with metabolic syndrome.