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Primary Prevention of Cardiovascular Disease Endpoints Using β-Blockers-Reply

Bruce M. Psaty, MD, PhD; Nicholas L. Smith, MPH; Thomas D. Koepsell, MD, MPH; Curt D. Furberg, MD, PhD
JAMA. 1997;277(22):1759-1760. doi:10.1001/jama.1997.03540460025019.
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In Reply.  —In our meta-analysis,1 we classified trials according to the "primary treatment strategy used in the active group." "While most studies," we stated, "used more than 1 drug in the treated group, the agents were usually applied in a stepped-care approach that was clearly identified." In other words, treatment strategies were defined by the first-line drug, and a variety of other drugs might also be used in the active group. Even the 2 MRC trials described by Dr Michalewicz and colleagues as "β-blocker studies" used supplemental drugs in 11% to 34% of subjects. Indeed, we drew attention to the ambiguous position of the STOP-H study, which "was classified as a β-blocker trial since the first-line agent for 68% in the active group was β-blocker therapy".1 This approach to classifying trials in terms of primary treatment strategies corresponds to the intention-to-treat principle and simply acknowledges the typical design features of


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