—Dr Liebson and colleagues criticized that TOMHS1 was not included in our meta-analysis on reversal of left ventricular hypertrophy in essential hypertension. The primary goal of the meta-analysis was "to determine the ability of various antihypertensive agents to reduce left ventricular hypertrophy." In the TOMHS trial, nutritional-hygienic treatment was compared with a combination of drug treatment and nutritional-hygienic intervention. Therefore, it seems impossible to separate the effect of antihypertensive agents per se from the effects of the intensive nonpharmacological intervention plus drug therapy, since interactions between the 2 therapeutic strategies most likely occurred. For instance, nonpharmacological intervention, including restriction of dietary salt intake and reduction of overweight in combination with a diuretic, resulted in a more marked decrease of left ventricular end-diastolic diameter than with other antihypertensive drugs (-0.7 mm vs -0.3 mm; P<.02).1 Whether the effect of the diuretic was attenuated or potentiated by the nonpharmacological
Schmieder RE. Regression of Left Ventricular Hypertrophy-Reply. JAMA. 1996;276(7):527. doi:10.1001/jama.1996.03540070023019
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