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 ß-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 ß-blockers is not biologically plausible and contradicts all evidence from randomized clinical trials [5].
1. Hoes AW, Grobbee DE, Lubsen J, Veld AJ, van der Does E, Hofman A. Diuretics, ß-blockers, and the risk for sudden cardiac death in hypertensive patients. Ann Intern Med. 1995; 123:481-7.
2. Aursnes I, Litleskare I, Froyland H, Abdelnoor M. Association between various drugs used for hypertension and risk of acute myocardial infarction. Blood Pressure. 1995; 4:157-63.
3. Taubes G. Epidemiology faces its limits. Science. 1995; 269:164-9.
4. Psaty BM, Heckbert SR, Koepsell TD, Siscovick DS, Raghunathan TE, Weiss NS. The risk of myocardial infarction associated with antihypertensive drug therapies. JAMA. 1995; 274:620-5.
5. Kendall MJ, Lynch KP, Hjalmarson [42], Kjekshus J. ß-blockers and sudden cardiac death. Ann Intern Med. 1995; 123:358-67.
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