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April 23/30, 2003

Long-term Cardiovascular Consequences of Diuretics vs Calcium Channel Blockers vs Angiotensin-Converting Enzyme Inhibitors

JAMA. 2003;289(16):2066. doi:10.1001/jama.289.16.2066-b

To the Editor: The ALLHAT authors1 concluded that diuretics are preferred for first-line therapy in most patients with hypertension. I am concerned, however, that many of the patients may have had salt-sensitive hypertension, for which diuretic therapy is especially efficacious. It is particularly prevalent among black, diabetic, and elderly patients.24 These groups comprised significant proportions of the patients (35%, 36%, and 57%, respectively). Patients younger than 55 years were not recruited and the mean age of the participants was 67 years. The proportion of patients having 1 or more characteristics predictive of the presence of salt sensitivity cannot be determined from the data presented in the article, but it is at least 57%, based on age alone.