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In Reply: The meta-analysis that we conducted in 1997¹ included the available evidence from placebo-controlled trials of -blockers and diuretics. Dr Messerli and colleagues question whether the findings of Lindholm et al² actually confirm ours. Regarding the placebo-controlled trials of -blockers, our findings agree with Figure 2A in Lindholm et al. For example, in both meta-analyses, -blockers compared with placebo were associated with a reduced risk of stroke but not coronary disease.^1-2 The 1997 JNC 6 recommendations³ were appropriately evidence-based, using the clinical trial findings of an actual health benefit as evidence.

The 1997 meta-analysis¹ also drew attention to the importance of low-dose diuretics, which were associated with decreased risks of stroke, coronary disease, heart failure, and total mortality. Our more recent 2003 meta-analysis⁴ provided additional evidence about the efficacy and safety of low-dose diuretic therapy, which led us to conclude that low-dose diuretics are the most effective first-line treatment . . . [Full Text of this Article]

Bruce M. Psaty, MD, PhD
psaty@u.washington.edu
Department of Medicine

Noel S. Weiss, MD, DrPH, MPH
Department of Epidemiology
University of Washington
Seattle

Curt D. Furberg, MD, PhD
Wake Forest University School of Medicine
Winston-Salem, NC