Mild Hypertension-Reply

Norman M. Kaplan, MD
Arch Intern Med. 1983;143(10):2015-2019. doi:10.1001/archinte.1983.00350100199048.
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In Reply.  —The VA trial found that hydrochlorothiazide therapy had greater antihypertensive efficacy than did propranolol therapy, particularly in blacks. This point has been shown before,1 though the agents have been shown to have virtually identical potency in other populations.2 In clinical practice, there is little to choose between them or other antihypertensive drugs in their ability to reduce BP, although most find that elderly persons and black hypertensives respond less well to β-blockers alone.3As to the potential arrhythmogenic risks of diuretic-induced hypokalemia, this remains the most logical reason for the higher coronary mortality-mostly sudden deaths—in the MRFIT patients who received more intensive, high-dose diuretic therapy and who had abnormal ECGs on entry into the trial. Additional evidence for the arrhythmogenic potential of diuretic-induced hypokalemia has come from the ongoing Medical Research Council of England trial of therapy for mild hypertension.4 A significantly higher frequency


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