The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack
Trial (ALLHAT) is a multicenter trial comparing treatment with a drug from
each of 3 classes of antihypertensive agents (amlodipine, a calcium antagonist;
lisinopril, an angiotensin-converting enzyme inhibitor; and doxazosin, an α-adrenergic
blocker) with the active control chlorthalidone, a diuretic, in 24,335 adults
with hypertension and at least 1 other coronary heart disease (CHD) risk factor.
In an interim analysisArticle (median follow-up, 3.3 years), there was no significant
difference in rates of fatal CHD or nonfatal myocardial infarction, or in
total mortality between the doxasozin and chlorthalidone groups, but rates
of stroke and combined cardiovascular disease events were significantly higher
in the doxazosin group. Mean systolic blood pressure in the doxazosin group
was about 2 to 3 mm Hg higher than in the chlorthalidone group and mean diastolic
pressure was the same. In an editorial, LasagnaArticle points out that these results
challenge the assumption that drugs that lower blood pressure equally have
equal clinical benefit.
Although risk-adjusted mortality rates for coronary artery bypass graft
(CABG) surgery at hospitals in New York State have been available since the
early 1990s, Erickson and colleaguesArticle report that from 1993 to 1996, patients
with private managed care insurance and Medicare managed care insurance were
significantly less likely than patients with private fee-for-service insurance
to receive CABG surgery at a lower-mortality hospital. In an editorial, JencksArticle
notes that use of comparative performance data by health care purchasers,
physicians, and patients must increase if publication of these data is to
create an effective market force for improved health care.
In a previously reported trial and 15-year follow-up of a prenatal and
infancy home nurse visitation program in a low-income primarily white population
in a semirural setting, women who received nurse visits during pregnancy and
the first 2 years after the birth of the first child had significant and enduring
benefits on maternal life course. Similar benefits were found in a second
trial in a low-income primarily black, urban population through the end of
the visitation program (2 years postpartum). In this follow-up 3 years after
the end of this second program, Kitzman and colleagues found that women who
received home visits had significantly fewer subsequent pregnancies, longer
intervals between the birth of the first and second child, and lower use of
welfare than women in the control group, but the magnitude of many of the
benefits on maternal life course was smaller than in the first trial.
Establishment of comprehensive systems of trauma care at the regional
or state level has been promoted since the 1970s, but evidence of the effectiveness
of organized trauma systems is limited. In this analysis comparing motor vehicle
crash mortality rates before and after implementation of an organized trauma
system in 22 states, 1979 through 1995, Nathens and colleagues found that
crash-related mortality declined after implementation of an organized trauma
system, but not until 10 years after implementation. About 15 years after
implementation, crash-related mortality was reduced by 8%.
Acute respiratory distress syndrome (ARDS) in adults has no proven effective
pharmacologic therapy. In this clinical trial, the first reported from the
multicenter ARDS Network, treatment of adults with early acute lung injury
or ARDS with ketoconazole, a synthetic imidazole with anti-inflammatory activity,
did not reduce in-hospital mortality or median number of ventilator-free days
compared with placebo.
"Anybody who wants to can, we believe, write a 55-word story." From
Advances in the development of polymers hold promise for such biomedical
uses as improving vision, implanting drugs, and engineering body parts.
Even in the presence of reactivity to control antigens, a negative tuberculin
skin test result does not exclude either latent infection or active disease.
Recommendations for reporting meta-analyses of observational studies
in epidemiology: results from an expert workshop.
JAMA acknowledges the authors of the 3978 manuscripts received in
1999, sincerely thanks the 3651 peer reviewers, and expresses appreciation
to our readers.
See Article and Article
For your patients: Testing for tuberculosis.
This Week in JAMA. JAMA. 2000;283(15):1931. doi:10.1001/jama.283.15.1931