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In Reply: We agree with Dr Choi and colleagues that direct comparisons within active control clinical trials are the optimal method of assessing differences between drugs. When the absence of active control data makes the use of indirect comparisons necessary, it is important to compare things that are similar.

Their reference to MRFIT¹ is surprising on several counts. First, they make an indirect comparison between hydrochlorothiazide and chlorthalidone even though the choice between the 2 diuretics was a local option and not a part of the randomized design. Second, for the randomized comparison between special intervention and usual care, MRFIT, which did not use a factorial design, has not generally been included in meta-analyses of hypertension trials² because the effects of antihypertensive treatment cannot be separated from the effects of the MRFIT nutrition and smoking interventions. Finally, high-dose diuretics were used in MRFIT. These differ from low-dose diuretics in their . . . [Full Text of this Article]

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

Thomas Lumley, PhD
University of Washington
Seattle

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

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