To the Editor: We read with interest the letter by Alfino et al. about methyldopa and carotid-sinus hypersensitivity (August 6 issue).1 We have paced 74 patients with hypersensitive-carotid-sinus syndrome. Eight patients (11 per cent) were taking methyldopa at the time of their diagnosis. There is an association between carotid-sinus syndrome and hypertension2 (26 per cent of patients in our series had hypertension), which may explain the finding of hypersensitive-carotid-sinus reflex in patients taking methyldopa (Aldomet). However, 42 per cent of our hypertensive patients were receiving this drug. This is an unexpectedly high incidence and suggests a direct association of carotid-sinus.