Primary Prevention of Cardiovascular Disease Endpoints Using β-Blockers

Leszek Michalewiz, MD; Tomasz Grodzicki, MD, PhD; Richard Chambers, MSPH
JAMA. 1997;277(22):1759. doi:10.1001/jama.1997.03540460025018.
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To the Editor.  —In their meta-analysis of the effect of antihypertensive therapies on preventing disease end points, such as stroke, coronary heart disease, congestive heart failure, and total and cardiovascular mortality, Dr Psaty and colleagues1 concluded that the data provide strong support for the use of β-blockers and diuretics as first-line agents. However, after a closer look at their data, these conclusions are not supported by the data in the case of β-blockers.When calculating the relative risk associated with β-blocker therapy, the authors used 4 studies: (1) Medical Research Council trial of treatment of mild hypertension (MRC)2; (2) Medical Research Council trial of treatment of hypertension in older adults (MRC-O)3; (3) Swedish Trial in Old Patients With Hypertension (STOP-H)4; and (4) Coope and Warrender.5 By doing so, they glossed over the fact that in STOP-H, two thirds of the patients in the active treatment


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