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-Blockers as First-Line Agents for Hypertension in the Elderly

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To the Editor: The systematic review by Dr Messerli and colleagues¹ based on 10 published studies concluded that diuretics are effective antihypertensive drugs, whereas -blockers should no longer be considered to be appropriate first-line therapy for uncomplicated hypertension in the elderly. On the basis of the data presented, the first conclusion is quite acceptable, whereas the second is not.

Thiazide diuretics are effective, inexpensive, once-daily antihypertensive drugs that are well tolerated by most patients. Thiazide diuretics markedly reduce cerebrovascular events and also decrease myocardial infarction (MI), but they do not reduce the risk of sudden death or the impact on sudden death is not reported.¹ This is of interest since it has been suggested that diuretics might increase the risk of sudden death.

The case against -blockers is based on the results of 2 studies.¹ Both studies used atenolol, a hydrophilic -blocker, which did not reduce coronary mortality in the . . . [Full Text of this Article]

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