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September 23, 1988

Primary Prevention With Metoprolol in Patients With Hypertension

Author Affiliations

University of Pennsylvania School of Medicine Philadelphia

University of Pennsylvania School of Medicine Philadelphia

JAMA. 1988;260(12):1715. doi:10.1001/jama.1988.03410120059019

To the Editor.—  The article by Wikstrand et al1 makes an important contribution to the role of β-blockers or nondiuretic therapy in the primary prevention of mortality from hypertension. However, several limitations of their study design need to be pointed out and their results need to be more closely compared with those of previous primary prevention trials.It is difficult to address mortality without also considering morbidity. Although morbidity also includes unwarranted side effects of medicines and quality of life considerations, the more disease-specific morbid events, such as the numbers of nonfatal myocardial infarctions and nonfatal strokes, need to be addressed. It is possible that patients taking β-blockers experienced more nonfatal myocardial infarctions and strokes and that the "cardioprotective" effects of β-blockade occur after a nonfatal event, as in most post-myocardial infarction β-blockade studies. Therefore, although total mortality is reduced, patients are left with significant morbidity.Other methodological problems