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March 11, 1998

Antihypertensive Therapy: Recommendations and Realities—Reply

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(10):746-747. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-10-jac80000

In Reply.—Drs Garvey and Garvey raise extremely important issues: the prevalence of adverse effects and quality of life associated with various classes of antihypertensives, and the need to individualize therapy. In terms of adverse effects and quality of life, 2 prospective placebo-controlled, blinded studies provide direct comparisons of different antihypertensive drugs. In 1 study, in which 902 men and women were studied for an average of 52 months,1 the differences in lipid levels and glucose levels between drugs were small, and the diuretic studied, chlorthalidone, was associated with the best quality of life and most effectively reduced left ventricular hypertrophy. Improvements in quality of life were observed in all randomized groups, but greater improvements were observed in the acebutolol and chlorthalidone groups and were evident throughout follow-up. In the Veterans Administration Cooperative Study,2hydrochlorothiazide was most effective in reducing left ventricular hypertrophy, and participants receiving either hydrochlorothiazide or atenolol tolerated these agents as well as, if not better than, participants receiving other drugs. In this study, no drug was associated with a significant increase in the frequency of impotence. In properly conducted placebo-controlled studies, diuretics and β-blockers are tolerated at least as well as other classes of antihypertensives.

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