Primary Prevention With Metoprolol in Patients With Hypertension

To the Editor.— We read with interest the recent article by Wikstrand and coworkers. 1 These investigators employed the Gehan-Wilcoxon nonparametric test for survival analysis and found in male hypertensive patients with diastolic blood pressures ranging from 100 through 129 mm Hg that total ( P =.028) and cardiovascular ( P =.012) mortality were reduced by metoprolol therapy compared with treatment with a thiazide diuretic. The 95% confidence interval for the reduction in total mortality at median follow-up (4.16 years) ranged from - 68% to -17%. However, the 95% confidence limits for the differences between the two treatment groups in cardiovascular mortality at median followup and in both total and cardiovascular mortality at the end of the study were not published. Using methods that were described previously 2 and the results published in Table 3 of the Metoprolol Atherosclerosis Prevention in Hypertensives Study, 1 we calculated these 95% confidence intervals. We confirmed that