This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Frohlich, E. D. Articles by Zanchetti, A. Search for Related Content PubMed PubMed Citation Articles by Frohlich, E. D. Articles by Zanchetti, A.

(Hypertension. 1996;27:317-318.)
© 1996 American Heart Association, Inc.

Antihypertensive Therapy: Safety and Efficacy of Drugs and Publications

Edward D. Frohlich, Editor of Hypertension; Alberto Zanchetti, Editor of the Journal of Hypertension

	Introduction

 
Periodically, in the history of antihypertensive therapeutics, there have been minor tempests that have significantly affected the utilization of entire classes of agents. The first storm struck with the case study report that suggested reserpine and its related compounds were associated with increased risk of carcinoma of the breast.¹ Despite its subsequent disproval of this association, the use of these agents was dramatically reduced in favor of newer agents.

The second storm was initiated by subanalysis of the MRFIT study,² from which it was inferred that in a subset of hypertensive patients (those with evidence of electrocardiographic abnormality) diuretic treatment may have been harmful rather than beneficial. Fuel was added to this fire from consecutive meta-analysis of available multicenter antihypertensive drug trials, in which diuretic- or beta-adrenergic receptor blocker-based therapy failed to reduce coronary events to a statistically significant extent. Even when in a further meta-analysis³ a statistically significant reduction was finally attained (P<.01), it was emphasized that, while a predicted 40 percent reduction in stroke was achieved, the significant 14 percent reduction in coronary morbidity and mortality was definitely lower than the predicted 20 to 25 percent reduction.

The results of these publications was an avalanche of speculative talks, articles, and editorials that suggested an adverse effect of diuretics that, either by raising serum lipid levels or by lowering serum potassium, led to a so-called "failure to prevent myocardial infarction." A subsequent meta-analysis included additional studies which employed lower diuretic doses and reported a reduction in cardiac . . . [Full Text of this Article]

This article has been cited by other articles:

				H. T. Stelfox, G. Chua, K. O'Rourke, and A. S. Detsky Conflict of Interest in the Debate over Calcium-Channel Antagonists N. Engl. J. Med., January 8, 1998; 338(2): 101 - 106. [Abstract] [Full Text] [PDF]