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Abstract-There has been a lot of interest about new-onset diabetes mellitus in recent hypertension trials, but the implications of diabetes development on cardiac outcomes have not been known. In the Valsartan Antihypertensive Long-Term Use Evaluation trial, 15 245 high-risk patients were followed for an average of 4.2 years. At baseline, 5250 patients were diabetic by the 1999 World Health Organization criteria, and among the 9995 nondiabetic patients, 1298 patients developed diabetes during follow-up. We have investigated the influence of diabetes development on outcomes in the Valsartan Antihypertensive Long-Term Use Evaluation trial. The patients with diabetes at baseline and new-onset diabetes were compared with patients who did not develop diabetes by a Cox regression model with adjustment for prespecified covariates (age, diabetes status, left ventricular hypertrophy, baseline coronary heart disease, and randomized study treatment). Patients with diabetes at baseline had the highest cardiac morbidity defined as myocardial infarction and heart failure with a hazard ratio of 2.20 (95% CI: 1.95 to 2.49). The patients with new-onset diabetes had significantly higher cardiac morbidity, especially more congestive heart failure, than those without diabetes, with a hazard ratio of 1.43 (95% CI: 1.16 to 1.77). This indicates that patients who develop diabetes during antihypertensive treatment have cardiac morbidity intermediate between diabetic subjects and those subjects who never had diabetes and that it is of importance to find these patients at risk of diabetes development and optimize lifestyle and medical treatment. Key Words: congestive heart failure Ⅲ diabetes mellitus Ⅲ hypertension Ⅲ morbidity Ⅲ myocardial infarction Ⅲ stroke T here has been a lot of interest in the development of diabetes mellitus in recent hypertension trials, because differences in new-onset diabetes between "old" and "new" antihypertensive treatments have been seen. Blockers of the renin-angiotensin system have seemed to be especially favorable in preventing or delaying diabetes development. Although it is well established that the coexistence of diabetes and hypertension portends a 2-to 3-fold higher risk of cardiovascular disease, 1 surprisingly few data exist on the prognostic impact of new-onset diabetes in initially nondiabetic patients, and the implications have been debated. 2 Some observational studies have reported the impact of new-onset diabetes in hypertensive subjects, 3,4 but the cohorts are small and the number of end points limited.The Valsartan Antihypertensive Long-term Use Evaluation (VALUE) trial 5-7 compared cardiac outcomes between the angiotensin II receptor blocker valsartan and the calcium channel blocker amlodipine in a population of hypertensive patients recruited according to a specific predefined age-and risk factor-dependent algorithm. 5 There were no differences seen between the 2 treatment regimens either in the primary composite cardiac end point or in all-cause mortality. 7,8 However, for 1 of the pr...