{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T00:38:56Z","timestamp":1790383136033,"version":"4.1.0"},"reference-count":30,"publisher":"American Diabetes Association","issue":"2","content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2008,2,1]]},"abstract":"<jats:p>OBJECTIVE\u2014Optimal initial antihypertensive drug therapy in people with the metabolic syndrome is unknown.<\/jats:p>\n               <jats:p>RESEARCH DESIGN AND METHODS\u2014We 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.<\/jats:p>\n               <jats:p>RESULTS\u2014In participants with metabolic syndrome, at 4 years of follow-up, the incidence of newly diagnosed diabetes (fasting glucose \u2265126 mg\/dl) was 17.1% for chlorthalidone, 16.0% for amlodipine (P = 0.49, chlorthalidone vs. amlodipine) and 12.6% for lisinopril (P &amp;lt; 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 &amp;lt; 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\u20131.35]). In comparison with lisinopril, chlorthalidone was superior in those with metabolic syndrome with respect to heart failure (1.31 [1.04\u20131.64]) and combined cardiovascular disease (CVD) (1.19 [1.07\u20131.32]). No significant treatment group\u2013metabolic syndrome interaction was noted.<\/jats:p>\n               <jats:p>CONCLUSIONS\u2014Despite 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.<\/jats:p>","DOI":"10.2337\/dc07-1452","type":"journal-article","created":{"date-parts":[[2008,1,28]],"date-time":"2008-01-28T22:25:09Z","timestamp":1201559109000},"page":"353-360","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":102,"title":["Metabolic and Clinical Outcomes in Nondiabetic Individuals With the Metabolic Syndrome Assigned to Chlorthalidone, Amlodipine, or Lisinopril as Initial Treatment for Hypertension"],"prefix":"10.2337","volume":"31","author":[{"given":"Henry R.","family":"Black","sequence":"first","affiliation":[{"name":"New York University School of Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barry","family":"Davis","sequence":"additional","affiliation":[{"name":"University of Texas Health Science Center at Houston School of Public Health, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Barzilay","sequence":"additional","affiliation":[{"name":"Kaiser Permanente of Georgia, Tucker, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuke","family":"Nwachuku","sequence":"additional","affiliation":[{"name":"National Heart, Lung, and Blood Institute, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Baimbridge","sequence":"additional","affiliation":[{"name":"University of Texas Health Science Center at Houston School of Public Health, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Horia","family":"Marginean","sequence":"additional","affiliation":[{"name":"Ottawa Hospital, Ottawa, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr.","given":"Jackson T.","family":"Wright","sequence":"additional","affiliation":[{"name":"General Clinical Research Center, University Hospitals of Cleveland, Cleveland, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Basile","sequence":"additional","affiliation":[{"name":"VA Medical Center Charleston, Charleston, South Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan D.","family":"Wong","sequence":"additional","affiliation":[{"name":"University of Southern California Medical Center, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Whelton","sequence":"additional","affiliation":[{"name":"Loyola University School of Medicine, Maywood, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard A.","family":"Dart","sequence":"additional","affiliation":[{"name":"Marshfield Clinic, Marshfield, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Udho","family":"Thadani","sequence":"additional","affiliation":[{"name":"University of Oklahoma Health Sciences Center, VA Medical Center, Oklahoma City, Oklahoma"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","reference":[{"key":"2022031216254288100_R1","doi-asserted-by":"crossref","unstructured":"Grundy SM, Brewer HB Jr, Cleeman JI, Smith SC Jr, Lenfant C, American Heart Association, National Heart, Lung and Blood Institute: Definition of metabolic syndrome: report of the National Heart, Lung, and Blood Institute\/American Heart Association conference on scientific issues related to definition. 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