The verdict from ALLHAT--thiazide diuretics are the preferred initial therapy for hypertension.

Quite simply, the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) is one of the most important trials of antihypertensive therapy. For decades, experts have passionately debated which class of drugs should be initial therapy for hypertension. Resolution of this issue, which has enormous clinical, public health, and economic implications, comes at a time of intense pressure to reduce health care costs while improving clinical outcomes. In this setting, the ALLHAT results, reported in this issue of THE JOURNAL, are particularly noteworthy, because there is no cost-quality tradeoff; the most effective therapy was also the least expensive.