In Reply We assessed chlorthalidone and hydrochlorothiazide in the treatment of hypertension by comparing the outcomes patients experience in real-world practice when their physicians prescribe them monotherapy.1 We acknowledge that our analysis with large-scale propensity adjustment2 and negative and positive control calibration3 cannot fully eliminate the possibility of residual confounding. The variables included in the analysis, however, are likely to be correlated with any unmeasured variables that might cause confounding. Moreover, physician factors, which were not directly controlled, would influence patient outcomes through correlation with patient-level characteristics associated with response or toxic effects, and would thereby be addressed by the propensity scoring methods.
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Hripcsak G, Shea S, Schuemie MJ. Chlorthalidone and Hydrochlorothiazide for Treatment of Patients With Hypertension—Reply. JAMA Intern Med. Published online June 22, 2020. doi:10.1001/jamainternmed.2020.1736
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