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To the Editor: The study by Dr Wassertheil-Smoller and colleagues¹ investigated cardiovascular outcomes in older women using various combinations of diuretics, -blockers, CCBs, and ACE inhibitors. However, it does not report results of the -blocker plus ACE inhibitor or the -blocker plus CCB combinations. The -blocker plus ACE inhibitor combination has gained attention following the ALLHAT study, which reported higher rates of cardiovascular disease, heart failure, and stroke for patients receiving an ACE inhibitor (lisinopril)². This combination was also found to be ineffective for control of blood pressure when -blocker monotherapy had failed³.

It is likewise important to consider that the combination of diuretic plus CCB is not optimal for control of blood pressure,⁴ and represents a flaw in this study. In contrast, diuretic plus ACE inhibitor, diuretic plus angiotensin receptor blocker, diuretic plus -blocker, diuretic plus central sympathetic inhibitor combinations, as well as CCB plus ACE inhibitor . . . [Full Text of this Article]

Michael Bursztyn, MD
bursz@cc.huji.ac.il
Hypertension Unit
Department of Medicine
Hadassah University Hospital, Mount Scopus
Jerusalem, Israel

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