We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editor's Correspondence |

Differences Between Primary vs Secondary Prevention Trials Regarding the Stroke Protective Effect of Antihypertensive Drugs—Reply

Olaf H. Klungel, PharmD, PhD; Hubert G. M. Leufkens, PharmD, PhD; Anthonius de Boer, MD, PhD; W. T. Longstreth, Jr, MD, MPH; Robert C. Kaplan, MS, PhD; Nicholas L. Smith, MPH, PhD; Bruce M. Psaty, MD, PhD
Arch Intern Med. 2001;161(17):2153-2154. doi:.
Text Size: A A A
Published online


In reply

In our case-control study of the association between antihypertensive drug therapies and the risk of ischemic stroke, we found that antihypertensive drug regimens that did not include a thiazide diuretic were associated with an increased risk of ischemic stroke. Fournier and colleagues are puzzled by the fact that among patients without cardiovascular complications, calcium antagonists were associated with an increased risk of ischemic stroke; whereas in the INSIGHT trial, long-acting nifedipine was not associated with an increased risk of stroke compared with the combination of hydrochlorothiazide and amiloride.1 In our study, the nondihydropyridines represented about 84% (176/209) of all calcium antagonist use as monotherapy. There were too few subjects receiving dihydropyridines to estimate the RR of ischemic stroke for these users. Therefore, our results are difficult to compare with those from the INSIGHT trial. Fournier and coworkers offer some interesting hypotheses regarding the potential role of angiotensin II and the difference in the stroke-protective effect of thiazide diuretics between subjects with and without cardiovascular complications. Indeed, non-BP–mediated effects of antihypertensive drugs are important to consider and emphasize the importance of evaluating antihypertensive drugs with regard to their effects on clinically important end points such as myocardial infarction and stroke.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles

Users' Guides to the Medical Literature
Clarifying Your Question

Users' Guides to the Medical Literature
Three Examples of Question Clarification