May 14, 1997

Adverse Outcomes of Underuse of β-Blockers in Elderly Patients-Reply

Author Affiliations

Harvard Medical School and Harvard Pilgrim Health Care
Harvard School of Public Health
Brigham and Women's Hospital Boston, Mass
University of California San Francisco

JAMA. 1997;277(18):1436-1437. doi:10.1001/jama.1997.03540420032022

In Reply.  —Dr Gambassi and colleagues and Dr Holt suggest that the nondihydropyridine calcium channel blockers (eg, verapamil and diltiazem) may be safer or more effective than dihydropyridine calcium channel blockers. However, our study was designed to measure outcomes of β-blocker underuse, not to assess the comparative efficacy of calcium channel blockers. A comparative study would require a different sample (not only patients eligible for β-blockers). Instead, we studied the effects of the substitution of any calcium channel blocker for a trial of β-blockers in patients eligible for β-blockers, a practice at odds with national evidence-based guidelines.1Gambassi et al also question whether 2 effective drug classes, aspirin and lipid-lowering agents, might be correlated with β-blocker use. Because aspirin is an over-thecounter drug, administrative claims databases do not contain reliable data on its use in community settings. However, a previous report from the United Kingdom indicates much greater use of aspirin