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To the Editor: The cohort study of cardiovascular outcomes and antihypertensive drug treatment by Dr Wassertheil-Smoller and colleagues¹ used data from the Women’s Health Initiative Observational Study. We have a number of concerns that we believe limit drawing conclusions from this study. First, relative to the study sample size, the number of incident events was small and therefore the study may not have had adequate power to detect the end points in each subgroup (Tables 4 and 5 in the original article). For example, among women receiving a calcium channel blocker (CCB) plus an angiotensin-converting enzyme (ACE) inhibitor, only 8 cardiovascular deaths were reported. The P values for the overall comparison of therapies only reached borderline statistical significance for cardiovascular mortality, the outcome with the lowest annualized rates.

Second, the confidence intervals reported for the hazard ratios in Tables 5 and 7 in the original article have not been adjusted . . . [Full Text of this Article]

Jan A. Staessen, MD, PhD
jan.staessen@med.kuleuven.ac.be

Lutgarde Thijs, BSc
Department of Molecular and Cardiovascular Research
University of Leuven
Leuven, Belgium

Jiguang Wang, MD, PhD; Yan Li, MD, PhD
Centre for Clinical Trials and Epidemiology
Shanghai Institute of Hypertension
Shanghai, China

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