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MAPHY and the Two Arms of HAPPHY

The Steering Committee of the HAPPHY Trial
JAMA. 1989;262(23):3273-3274. doi:10.1001/jama.1989.03430230044024.
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To the Editor.—  The Heart Attack Primary Prevention in Hypertension (HAPPHY) Trial started in 1976 and results were published in 1987.1 The main objective of the HAPPHY Trial was to determine whether antihypertensive treatment with β-blockers (atenolol, metoprolol, or propranolol) differed from thiazide diuretic (bendroflumethiazide [bendrofluazide] or hydrochlorothiazide) treatment with respect to the incidence of nonfatal myocardial infarction, mortality from coronary heart disease, and total mortality in men with mild to moderate hypertension. No significant difference between β-blockers and diuretics regarding the above-mentioned end points was found.The Steering Committee decided early on that any comparison of the effect of the β-blockers against each other should not be performed, owing to the fact that there was no randomization between centers choosing different alternatives. This militated against a valid comparison of the β-blockers or of the diuretics used in the trial. Furthermore, too few patients and end points were expected


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