RSS Feeds
Angiotensin-Converting Enzyme Inhibitors and Diuretics: Optimal Combination Therapy
- Barry R. Davis, MD, PhD;
- Curt D. Furberg, MD, PhD;
- Jackson T. Wright, Jr., MD, PhD;
- Jeffrey A. Cutler, MD, MPH; and
- Paul Whelton, MD, MSc
- From The University of Texas School of Public Health at Houston, Houston, TX 77030; Wake Forest University School of Medicine, Winston-Salem, NC 27157; Case Western Reserve University, Cleveland, OH 44106; National Heart, Lung, and Blood Institute, Bethesda, MD 20892; and Tulane University Health Sciences Center, New Orleans, LA 70112.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
IN RESPONSE:
We thank Dr. Krantz for his thoughtful letter. The proposed strategy of using a diuretic and an ACE inhibitor simultaneously is supported by the effects of combined treatment in the Perindopril Protection Against Recurrent Stroke Study (PROGRESS) (1). However, that study could also be (and was) interpreted as showing that it's the blood pressure that matters, especially for stroke, and blood pressure reduction is much more effective with a diuretic in the regimen. Although the use of ACE inhibitors could in theory offset the metabolic effects (higher glucose and lower potassium levels) of thiazides, other potassium-sparing regimens may be just as or more effective, and a randomized trial to compare such regimens would be valuable. In addition, minimizing the metabolic effects would not necessarily translate into lower rates of important clinical outcomes, including coronary heart disease, stroke, and heart failure. Therefore, an events trial is also needed to test initiating treatment with different 2-drug combinations where 1 of the drugs is a thiazide diuretic.
Barry R. Davis, MD, PhD
The University of Texas School of Public Health at Houston; Houston, TX 77030
Curt D. Furberg, MD, PhD
Wake Forest University School of Medicine; Winston-Salem, NC 27157
Jackson T. Wright Jr., MD, PhD
Case Western Reserve University; Cleveland, OH 44106
Jeffrey A. Cutler, MD, MPH
National Heart, Lung, and Blood Institute; Bethesda, MD 20892
Paul Whelton, MD, MSc
Tulane University Health Sciences Center; New Orleans, LA 70112
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
