Clinical Outcomes in Antihypertensive Treatment of Type 2 Diabetes, Impaired Fasting Glucose Concentration, and Normoglycemia

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Abstract
The combination of hypertension and type 2 diabetes mellitus (DM) is common and results in a potent milieu for risk of cardiovascular disease (CVD) and end-stage renal disease.1-4 Less striking elevations of blood pressure (BP) and impairments of glucose homeostasis such as high normal BP and impaired fasting glucose level (IFG) also increase risk.3,5,6 Lowering BP may provide the most effective means to reduce the risk of CVD in patients with DM.7,8 Agents that interfere with the renin-angiotensin system, especially angiotensin-converting enzyme inhibitors (ACEIs), have been recommended as first-step antihypertensive treatment in patients with DM and proteinuria.9,10 There is less certainty, however, regarding the optimal choice of first-step antihypertensives in patients with DM and hypertension who have little or no renal damage.10,11 The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) was designed to determine whether first-step antihypertensive drug therapy with an ACEI, a calcium channel blocker (CCB), or an α-adrenergic blocker would provide better protection against CVD compared with diuretic therapy.12 A comparison of treatment efficacy in participants with or without DM was prespecified in the ALLHAT protocol.12 Our group has previously described its experience with first-step antihypertensive therapy using a diuretic compared with an α-adrenergic blocker in ALLHAT participants with and without glucose disorders.13 We herein report on the efficacy of first-step antihypertensive therapy with a diuretic compared with a CCB or an ACEI in the following 3 baseline glycemic strata: DM, IFG, and normoglycemia (NG).