Thiazide Exposure and Cardiovascular Risk in Type 2 Diabetes Mellitus: A Point of Clarification

Hypertension. 2020 Mar;75(3):e2-e5. doi: 10.1161/HYPERTENSIONAHA.119.14447. Epub 2020 Feb 3.


A recently published analysis in Hypertension suggests that thiazide use, versus nonuse, is associated with excess risk of adverse cardiovascular outcomes in patients with diabetes mellitus enrolled in the ACCORD trial (Action to Control Cardiovascular Risk in Diabetes). Here, we replicate these findings using the same publicly available datasets and following their reported methods. We further show that possible misclassification of thiazide exposure exists in the original analysis. We perform alternative analyses that correct for this misclassification to highlight the impact that misclassification can have on observed associations between an exposure (eg, thiazides) and outcomes (eg, stroke and major adverse cardiovascular events).

Publication types

  • Letter
  • Research Support, N.I.H., Extramural
  • Comment

MeSH terms

  • Blood Pressure
  • Cardiovascular Diseases* / chemically induced
  • Cardiovascular Diseases* / epidemiology
  • Diabetes Mellitus, Type 2* / drug therapy
  • Diabetes Mellitus, Type 2* / epidemiology
  • Heart Disease Risk Factors
  • Humans
  • Hypertension*
  • Risk Factors
  • Sodium Chloride Symporter Inhibitors / adverse effects
  • Thiazides / adverse effects


  • Sodium Chloride Symporter Inhibitors
  • Thiazides