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To the Editor.—
The article by Kaplan (135:660-663, 1975) promised much, but fell short of the mark. The idea that a diuretic-induced increase in plasma renin activity (PRA) reduced its antihypertensive effect (via secondary aldosteronism) was thought-provoking, and the author implied that the data support the proposition. In fact, the data presented do not support the proposition, and the protocol used is incapable of such.If the proposition presented was indeed correct, in the group of patients receiving diuretic plus methyldopa first (A + D), the removal of methyldopa from the regimen, which resulted in a substantial increase in PRA (455 to 644), should have been accompanied by an increase in blood pressure; mean arterial pressure only went from 116 to 117 mm Hg. Also, the fact that addition of methyldopa to diuretic (D-first group) resulted in a substantial fall in blood pressure, without a statistically significant fall in PRA also
Pomeroy PR. Antihypertensive Drugs. Arch Intern Med. 1976;136(1):118. doi:10.1001/archinte.1976.03630010096020