February 21, 1996

Myocardial Infarction Associated With Antihypertensive Drug Therapy

Author Affiliations

Bowling Green, Ohio

JAMA. 1996;275(7):515. doi:10.1001/jama.1996.03530310021013

To the Editor.  —The study by Dr Psaty and colleagues1 is simply a lesson in what happens when one does not learn from failures of the past. In brief, Psaty and colleagues reviewed charts of hypertensive patients in the Group Health Cooperative (GHC) of Puget Sound in Washington States, a plan that appears to be a health maintenance organization that controls the medications dispensed by its pharmaceutical outlets. As a result, long after immediate-release calcium channel blockers (CCBs) became irrelevant to mainstream medical practice, some patients continued to receive them in preference to sustained-release CCBs, which probably, at least in part, was due to cost-containment measures.As was the standard of practice during the study period, GHC physicians prescribed CCBs for patients with complicated hypertension, such as those with atherosclerotic heart disease (ASHD). This is borne out by the increased prevalence of ASHD in patients who have been prescribed