September 23, 1988

Primary Prevention With Metoprolol in Patients With Hypertension

Author Affiliations

The Cleveland Clinic Foundation

The Cleveland Clinic Foundation

JAMA. 1988;260(12):1714-1715. doi:10.1001/jama.1988.03410120059017

To the Editor.—  The design of the Metoprolol Atherosclerosis Prevention in Hypertensives (MAPHY) Study1 is as unorthodox as the results are surprising.How can deletion of the half of the original cohort from centers not electing to use metoprolol as the β-blocker in the Heart Attack Primary Prevention in Hypertensives (HAPPHY) trial and extension of the period of observation for only 15 months yield findings so disparate from those of the parent HAPPHY trial? If smoking men randomized to metoprolol treatment in the MAPHY Study had a significantly lower mortality rate than those randomized to diuretic treatment, yet in the HAPPHY trial there was no difference in mortality between men taking β-blocker (metoprolol or atenolol) and those taking diuretics, irrespective of smoking habits, it seems inescapable that in the atenolol group that was deleted from the MAPHY Study the mortality rate must have been significantly higher for men taking the