The optimal antihyper- tensive drug therapy for patients with hypertension in the setting of the metabolic syndrome has not been clearly Although caution exists with regard to the use of thiazide diuretics in this population because of their abil- ity to increase insulin resistance, dyslipidemia, and hyper- uricemia and to accelerate conversion to overt DM, no data are currently available demonstrating deterioration in car- diovascular or renal outcomes in patients treated with these Indeed, as shown in follow-up of ALLHAT, chlorthalidone use was associated with only a small increase in fasting glucose levels (1.5 4.0 mg/dL), and this increase did not translate into increased CVD risk at a later date.S9.7-7 In addition, in post hoc analysis of the nearly two thirds of participants in ALLHAT that met criteria for the meta- bolic syndrome, chlorthalidone was unsurpassed in reducing CVD and renal outcomes compared with lisinopril, amlo- dipine, or doxazosin.S9.7-9,S9.7-11 Similarly, high-dose ARB therapy reduces arterial stiffness in patients with hyperten- sion with the metabolic syndrome, but no outcomes data are available from patients in which this form of treatment was Use of traditional beta blockers may lead to dys- lipidemia or deterioration of glucose tolerance, and ability to lose weight.S9.7-2 In several large clinical trials, the risk of developing DM as a result of traditional beta-blocker therapy However, the newer vasodilating beta blockers (eg, labetalol, carvedilol, nebivolol) have shown neutral or favorable effects on metabolic profiles compared with the traditional beta blockers.S9.7-13 Trials using vasodila- tor beta blockers have not been performed to demonstrate effects on CVD outcomes. 9.8. Atrial Fibrillation Recommendation for Treatment of Hypertension in Patients With AF References that support the recommendation are summarized in Online Data Supplement 48. COR LOE Recommendation IIa B-R 1. 