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To the Editor: In emphasizing the benefits of losartan on stroke reduction, Dr Kjeldsen and colleagues¹ state that "Previous intervention studies in ISH with diuretic or -blocker or calcium antagonists or angiotensin-converting enzyme inhibitors have shown 36%, 42%, and 38% reductions in stroke vs placebo. A further 40% reduction in stroke with losartan-based therapy . . . is an important finding. . . . " The authors imply that a reduction in strokes in the order of magnitude of 80% would have been achieved had losartan been compared with placebo instead of atenolol. In the 3 studies the authors use to compute these estimates, antihypertensive therapy against placebo was either based on diuretics (in the SHEP trial) or calcium antagonists (in the Syst-Eur and Syst-China trials), and no data were given on -blockers or ACE inhibitors. In the SHEP study, atenolol, when added to diuretic therapy in some patients, did . . . [Full Text of this Article]

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Messerli and Fournier
J Am Coll Cardiol 2004;44:2097-2098.
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