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To the Editor: In the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT),¹ there were more deaths, cardiovascular events, and strokes in patients whose hypertension was treated with a -blocker (supplemented with a diuretic) than those treated with a calcium channel blocker (supplemented with an angiotensin-converting enzyme inhibitor). In their Commentary, Dr Psaty and colleagues² discuss ASCOT and assert that it was fatally flawed because diuretics (which they describe as "unsurpassed" in the treatment of hypertension) were not given to 45% of the individuals in the -blocker arm. They also consider that atenolol, the -blocker used in ASCOT, is less cardioprotective than other -blockers.

However, the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), the largest direct comparison of diuretics, calcium channel blockers, and angiotensin-converting enzyme inhibitors, did not demonstrate that diuretics were superior to other antihypertensive medications. Rather, it found that they had similar efficacy as treatment with other single . . . [Full Text of this Article]

Simeon Pollack, MD
simeonpollack@optonline.net
Department of Medicine
Albert Einstein College of Medicine
Bronx, NY

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