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	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: Dr Psaty and colleagues¹ compared the results of 2 meta-analyses, each of which looked individually at the efficacy of either chlorthalidone or other low-dose diuretics compared with placebo, not with each other. Based on small efficacy differences, Psaty et al concluded that "major health outcomes for chlorthalidone and other thiazide-like drugs appear to be similar." We believe that it is necessary to directly compare treatments to reach conclusions about differences between them.

Evidence from active control clinical trials distinguishes chlorthalidone from diuretics that are similar but hardly identical.² After an interim analysis at 5 years of follow-up in the Multiple Risk Factor Intervention Trial (MRFIT), the steering committee recommended that only chlorthalidone (and not hydrochlorothiazide) be used in the intervention arm.³ In the 9 clinics whose staff initially prescribed predominantly hydrochlorothiazide, coronary heart disease (CHD) mortality and all-cause mortality were increased by 44% and 16%, respectively, . . . [Full Text of this Article]

Kenneth L. Choi, MD
kenneth_choi@rush.edu

Dave Chua, MD, MS; William J. Elliott, MD, PhD
Department of Preventive Medicine
Rush University Medical Center
Chicago, Ill

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