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Primary Prevention With Metoprolol in Patients With Hypertension

Samuel J. Mann, MD
JAMA. 1988;260(12):1715. doi:10.1001/jama.1988.03410120059020.
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To the Editor.—  In the recent article "Primary Prevention With Metoprolol in Patients With Hypertension,"1 the authors reported a higher death rate with diuretic than with metoprolol treatment. The results differ from the findings of the Medical Research Council trial2 and, it is suggested, may have important implications in clinical practice.In the article, the average dose of hydrochlorothiazide was 46 mg, and 13% of patients treated with diuretics were hypokalemic (<3.6 mEq/L). I imagine that many patients received 75 to 100 mg/d and may have constituted a majority of the hypokalemic patients.The past few years have seen support for treatment of hypertension with lower doses of hydrochlorothiazide, with 25 mg being the dose used by many practitioners. The use of potassium-sparing diuretics, alone or in combination with thiazides, also has been advocated. Using these guidelines, the incidence of hypokalemia is considerably lessened.I would like to


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