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April 16, 2003

Reducing the Risk of Stroke

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289(15):1927-1929. doi:10.1001/jama.289.15.1927

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.