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Differences Between Primary vs Secondary Prevention Trials Regarding the Stroke Protective Effect of Antihypertensive Drugs
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In the very interesting case-control study by Klungel et al,1 we noted 2 intriguing observations about which
we would like to comment: (1) among patients without cardiovascular complication
treated with monotherapy, the risk ratio (RR) for ischemic stroke was much
higher in those treated with calcium antagonist alone (RR, 2.30; 95% confidence
interval [CI], 1.16-4.56) compared with those treated with thiazide alone;
(2) among patients treated with 1 or 2 drugs, the risk of ischemic stroke
associated with no thiazide treatment compared with thiazide treatment was
remarkably higher in those with clinically recognized cardiovascular disease
than in those without this complication (RR, 1.85 vs 1.25; 95% CI, 1.26-2.71
vs 0.87-1.80).
Regarding the first observation, we are puzzled by the fact that the
greater stroke protective effect of thiazide over calcium antagonists suggested
by this case-control study is not confirmed by the results of more reliable
randomized controlled trials. Thus, in . . . [Full Text of this Article]
RELATED ARTICLE
Antihypertensive Drug Therapies and the Risk of Ischemic Stroke
Olaf H. Klungel, Susan R. Heckbert, W. T. Longstreth, Jr, Curt D. Furberg, Robert C. Kaplan, Nicholas L. Smith, Rozenn N. Lemaitre, Hubert G. M. Leufkens, Anthonius de Boer, and Bruce M. Psaty
Arch Intern Med. 2001;161(1):37-43.
ABSTRACT
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