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To the Editor: In their Commentary, Dr Psaty and colleagues¹ stated that recent meta-analyses by Carlberg et al² and Lindholm et al³ confirm their own previous meta-analysis.⁴ However, their conclusions in that review were that "the available scientific evidence provides strong support for the current national guidelines, which recommend diuretics and -blockers as first-line agents . . . ." In contrast, Carlberg et al² concluded that "our results cast doubts on atenolol as a suitable drug for hypertensive patients." Lindholm et al³ concluded that "we believe that -blockers should not remain first choice in the treatment of primary hypertension . . . ."

-Blockers remained first-line therapy for hypertension on an equal basis with diuretics in the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 6) despite evidence of their inefficacy for this indication.⁵ As a consequence, atenolol has become the fourth most prescribed drug in the United . . . [Full Text of this Article]

Franz H. Messerli, MD
fmesserli@aol.com
Division of Cardiology
St Luke’s-Roosevelt Hospital Center
New York, NY

Gareth Beevers, MD
University Department of Medicine
City Hospital
Birmingham, England

Stanley S. Franklin, MD
Heart Disease Prevention Program
University of California, Irvine

Thomas G. Pickering, MD
Columbia University
New York, NY

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