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Primary Prevention With Metoprolol in Patients With Hypertension

Philip Altus, MD
JAMA. 1988;260(12):1715. doi:10.1001/jama.1988.03410120059018.
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To the Editor.—  The results of the Metoprolol Atherosclerosis Prevention in Hypertensives (MAPHY) Study,1 showing lower mortality with metoprolol use compared with thiazide diuretic therapy, is concordant with many of our beliefs that thiazides are potentially harmful while β-blockers may be cardioprotective. The MAPHY Study, by Wikstrand et al, used neither a placebo group nor actuarial data. As such, three possibilities exist. β-Blockers may be mortality neutral while diuretics have increased mortality, β-blockers may be cardioprotective while diuretics are mortality neutral, or β-blockers are cardioprotective and diuretics have increased mortality. In a previous study by Morgan et al,2 moderately hypertensive men were treated with either placebo, low-salt diet, high-dose thiazide, or β-blocker. When compared with actuarial data there were twice as many deaths than predicted in the diuretic-treated group and expected numbers of deaths in all other groups. In the study by Wikstrand et al it is clear


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