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Primary Prevention of Cardiovascular Disease Endpoints Using β-Blockers FREE

Leszek Michalewiz, MD; Richard Chambers, MSPH; Tomasz Grodzicki, MD, PhD
JAMA. 1997;277(22):1759-1759. 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

REFERENCES

Psaty BM, Smith NL, Siscovick DS, et al.  Health outcomes associated with antihypertensive therapies used as first-line agents: a systematic review and metaanalysis . JAMA . 1997;;277:739-745.
Medical Research Council Working Party.  MRC trial of treatment of mild hypertension: principal results . BMJ . 1985;;291:97-104.
Medical Research Council Working Party.  Medical Research Council trial of treatment of hypertension in older adults: principal results . BMJ . 1992;;304:405-412.
Dahlof B, Lindholm LH, Hansson B, Schersten B, Ekbom T, Wester PO.  Morbidity and mortality in the Swedish Trial in Old Patients With Hypertension (STOP-Hypertension) . Lancet . 1991;;338:1281-1285.
Coope J, Warrender TS.  Randomised trial of treatment of hypertension in elderly patients in primary care . BMJ . 1986;;243:1145-1151.

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Psaty BM, Smith NL, Siscovick DS, et al.  Health outcomes associated with antihypertensive therapies used as first-line agents: a systematic review and metaanalysis . JAMA . 1997;;277:739-745.
Medical Research Council Working Party.  MRC trial of treatment of mild hypertension: principal results . BMJ . 1985;;291:97-104.
Medical Research Council Working Party.  Medical Research Council trial of treatment of hypertension in older adults: principal results . BMJ . 1992;;304:405-412.
Dahlof B, Lindholm LH, Hansson B, Schersten B, Ekbom T, Wester PO.  Morbidity and mortality in the Swedish Trial in Old Patients With Hypertension (STOP-Hypertension) . Lancet . 1991;;338:1281-1285.
Coope J, Warrender TS.  Randomised trial of treatment of hypertension in elderly patients in primary care . BMJ . 1986;;243:1145-1151.
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To understand the clinical management of acute heart failure syndromes.
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