Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
In Reply: Like Dr Fournier and colleagues,
we are uncertain about the possibility of class-specific differences in clinical
outcomes (such as stroke or myocardial infarction) among antihypertensive
drugs. Although debate continues about their relative efficacies, thiazide
diuretics, β-blockers, angiotensin-converting enzyme inhibitors, angiotensin
receptor blockers, and long-acting dihydropyridine calcium channel blockers
have been shown to reduce the risk of stroke. However, given the results of
the recently published ALLHAT trial1 and
the relative costs of the various agents, we believe that thiazide diuretics
remain the agents of first choice in hypertensive patients for the primary
prevention of cardiovascular and cerebrovascular disease. Furthermore, a meta-regression
of 27 antihypertensive drug trials found that the reductions in stroke (as
well as other cardiovascular end points) from antihypertensive therapy observed
in these trials could be explained by the achieved differences in SBP.2 Of note, this meta-regression included the CAPPP
trial that Fournier et al mention.
Straus SE, McAlister FA, Majumdar SR. Reducing the Risk of Stroke. JAMA. 2003;289(15):1927–1929. doi:10.1001/jama.289.15.1927
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