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Primary Prevention With Metoprolol in Patients With Hypertension

Lars Wilhelmsen, MD, PhD
JAMA. 1988;260(12):1713. doi:10.1001/jama.1988.03410120059014.
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To the Editor.—  The Heart Attack Primary Prevention in Hypertension (HAPPHY) trial was published in 1987.1 The main objective of the HAPPHY trial was to determine whether antihypertensive treatment with β-blockers differed from thiazide diuretic 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. The trial recruited 6569 patients from 184 centers. Centers could choose either atenolol or metoprolol as a β-blocker and bendrofluazide or hydrochlorothiazide as a thiazide diuretic. The trial was closed according to the protocol on Dec 31, 1985. Total mortality, incidence of coronary heart disease, and incidence of stroke did not differ between the β-blocker-treated group and the diuretic-treated group.When the HAPPHY trial was closed, investigators at centers that used metoprolol decided to continue follow-up of patients in the trial randomized to treatment with metoprolol or with a


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