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To the Editor: The ALLHAT authors¹ concluded that diuretics are preferred for first-line therapy in most patients with hypertension. I am concerned, however, that many of the patients may have had salt-sensitive hypertension, for which diuretic therapy is especially efficacious. It is particularly prevalent among black, diabetic, and elderly patients.^2-4 These groups comprised significant proportions of the patients (35%, 36%, and 57%, respectively). Patients younger than 55 years were not recruited and the mean age of the participants was 67 years. The proportion of patients having 1 or more characteristics predictive of the presence of salt sensitivity cannot be determined from the data presented in the article, but it is at least 57%, based on age alone.

I applaud the diversified recruitment that addressed previous underrepresentation of age, race, sex, and comorbidities. However, I am not convinced that these results are generalizable to a significant proportion of patients with hypertension, . . . [Full Text of this Article]

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