To the Editor: In the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT),1 there were more deaths, cardiovascular events, and strokes in patients whose hypertension was treated with a β-blocker (supplemented with a diuretic) than those treated with a calcium channel blocker (supplemented with an angiotensin-converting enzyme inhibitor). In their Commentary, Dr Psaty and colleagues2 discuss ASCOT and assert that it was fatally flawed because diuretics (which they describe as “unsurpassed” in the treatment of hypertension) were not given to 45% of the individuals in the β-blocker arm. They also consider that atenolol, the β-blocker used in ASCOT, is less cardioprotective than other β-blockers.
Pollack S. Clinical Trials in Hypertension. JAMA. 2006;296(12):1463-1465. doi:10.1001/jama.296.12.1464-a