In Reply. —
Parving's letter raises some important points that were not addressed in our article1 regarding excess mortality associated with diuretic therapy in patients with diabetes.First, we did not cite the European "trials"2 evaluating the effects of antihypertensive drugs for the reason that they were conducted among young patients, and it is well known that few of these patients die before age 35 years. When they do, it is mainly due to uremia. The patients in our study were over 35 years of age and were, therefore, in an age group where the risk of cardiovascular death is as great as the risk of uremic death.3 The important clinical question is whether it is possible to protect the kidney with antihypertensive treatment and, at the same time, reduce the risk of cardiovascular death. There has been no randomized clinical trial addressing this question.Second, the
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