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Comment & Response |

Guidelines for Managing High Blood Pressure

Alberto Morales-Salinas, MD, MPH1; Antonio Coca, MD, PhD, FRCP2; Fernando Stuardo Wyss, MD, PhD3
[+] Author Affiliations
1Department of Cardiology, Cardiocentro “Ernesto Che Guevara,” Santa Clara, Cuba
2Department of Internal Medicine, University of Barcelona, Barcelona, Spain
3Department of Cardiology, Hospital General San Juan de Dios, Guatemala City, Guatemala
JAMA. 2014;312(3):293-294. doi:10.1001/jama.2014.6590.
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To the Editor Some evidence against β-blockers1 has been published in recent years; however, the exclusion of these drugs as initial treatment of uncomplicated hypertension in the report from the panel members appointed to the Eighth Joint National Committee (JNC 8)2 is surprising.

First, the evidence against atenolol was presented in only 1 study, the Losartan Intervention for Endpoint Reduction in Hypertension Study (LIFE),3 and the quality of this evidence was classified as weak by the panel. Results from LIFE cannot be extrapolated to the general population because the patients included were a high-risk sample with ventricular hypertrophy by electrocardiography and a high prevalence of diabetes mellitus (13%) and cardiovascular disease (25%). Also, the mean age in LIFE was 66.9 years, and it has been shown that β-blockers can be more effective in patients with hypertension who are younger than 60 years.4 In other studies that analyzed a general population, the performance of β-blockers was similar to that of other drugs or the evidence was not sufficient to draw conclusions.

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July 16, 2014
Eduardo Ortiz, MD, MPH; Suzanne Oparil, MD; Paul A. James, MD
1Rockville, Maryland4Dr Ortiz was with the National Heart, Lung, and Blood Institute, Bethesda, Maryland, at the time of the project
2University of Alabama at Birmingham School of Medicine
3University of Iowa, Iowa City
JAMA. 2014;312(3):295-296. doi:10.1001/jama.2014.6599.
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