Don’t diuretics have a lot of side effects (including hypokalemia and hyperglycemia). Will my patients continue to take them on a long-term basis?
ALLHAT confirms findings from previous studies indicating that thiazide-type diuretic therapy is associated with higher glucose and lower potassium levels, and therefore, it is advisable to monitor potassium levels periodically in patients taking diuretics. However, the important concept to remember is that in ALLHAT, where serum potassium was monitored and potassium supplements provided as necessary, these metabolic differences did not translate into more adverse clinical outcomes with chlorthalidone. The results of ALLHAT show us that diuretic therapy was well tolerated. The percentage of patients who remain on their initially prescribed medication is one measure of how well it is tolerated. In ALLHAT, 80% of patients who were assigned to chlorthalidone remained on it (or other of the same class) after 5 years, which is similar to amlodipine (80%) and better than lisinopril (73%).
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