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November 19, 1997

Risk of Hypoglycemia With Antihypertensive Medication-Reply

Author Affiliations

Methodist Hospitals of Memphis Memphis, Tenn
Vanderbilt University School of Medicine Nashville, Tenn

JAMA. 1997;278(19):1570-1571. doi:10.1001/jama.1997.03550190034032

In Reply  —Choice of antihypertensive drug therapy may be linked to unmeasured patient attributes or prescriber behavior that could be associated with risk of hypoglycemia. For example, if prescribers were more cautious in avoiding hypoglycemia in persons using β-blockers, as Drs Suissa and Garbe describe, then our findings would underestimate the risk of hypoglycemia associated with exposure to β-blockade. We attempted to estimate degree of glycemic control in our population using 2 variables: use of capillary fingerstick equipment and the level of glycosylated hemoglobin reported in the medical records of the cases. Less than 2% of the study population submitted a claim for capillary fingerstick equipment, and glycosylated hemoglobin was virtually never found in medical records.1,2Even in this large study, the number of events associated with some of the drug-drug combinations was small, which resulted in wide CIs, as described by Dr Gambassi and colleagues. Because of the small numbers