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Diuretics and Sudden Cardiac Death
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
TO THE EDITOR:
The article by Hoes and colleagues [1] calls for a general comment on the value of observational data in research related to the effects of antihypertensive drugs. Both our experiences in this field [2] and recently expressed views [3] suggest that caution should be used when such data are interpreted. Our results, which address the occurrence of acute myocardial infarction in hypertensive patients, conflict with those of another study that had a similar study design [4]. Taubes [3] expressed the view that relative risk should be large, various investigators should be unanimous, and the outcome should have a plausible mechanism before conclusions are drawn from observational data. Unfortunately, the report by Hoes and colleagues [1] meets none of these criteria. It is evident from Table 1 of their article that the controls and case-patients had different characteristics: Case-patients were more prone to coronary disease and heart failure. It seems far too optimistic to assume that the effect of this finding on the choice of drugs can fully be addressed in the calculations of the odds ratios comparing the use of β-blockers and non-potassium-sparing diuretics with other antihypertensive drugs. Moreover, the lower bound of the CI approaches 1.0 (that is, no effect). Thus, the finding of an increased occurrence of sudden death with β-blockers is not biologically plausible and contradicts all evidence from randomized clinical trials [5].
Ivar A. Aursnes, MD, PhD
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
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