The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack
Trial (ALLHAT) is a randomized trial that compared treatment with a drug from
each of 3 classes of antihypertensive agents (amlodipine, a calcium channel
blocker; lisinopril, an angiotensin-converting enzyme inhibitor; and doxazosin,
an α-adrenergic blocker) with chlorthalidone, a thiazide diuretic, in
adults with hypertension and at least 1 other coronary heart disease (CHD)
risk factor. The doxazosin arm was terminated early because rates of cardiovascular
disease events were significantly higher than in the chlorthalidone group.
In this reportArticle of outcomes after a mean of 4.9 years of follow-up, the rate
of combined fatal CHD or nonfatal myocardial infarction in the amlodipine
and lisinopril groups was not significantly different from that in the chlorthalidone
group, but the rate of heart failure was higher in the amlodipine group, and
the rate of combined cardiovascular disease events was higher in the lisinopril
group. In an editorial, AppelArticle concludes that thiazide diuretics should be
considered the preferred initial therapy for hypertension.
The lipid-lowering trial (LLT) of the Antihypertensive and Lipid-Lowering
Treatment to Prevent Heart Attack Trial (ALLHAT)Article, a nonblinded randomized
substudy of the ALLHAT hypertension trial also reported in this issue of THE
JOURNAL, compared the effect of pravastatin therapy with usual care on all-cause
mortality and coronary heart disease (CHD) outcomes among ALLHAT participants
with moderate hypercholesterolemia. After a mean of 4.8 years of follow-up,
all-cause mortality and CHD event rates were not significantly different in
the 2 study groups. In an editorial, PasternakArticle notes that the difference in
cholesterol lowering between the study groups in this trial was small, indicating
that cholesterol lowering is central to achieving the benefits of statin therapy.
In this analysis of cases of cardiac arrest who received advanced life
support from Seattle Fire Department emergency medical services, Cobb and
colleaguesArticle found that the annual incidence of cardiac arrest with ventricular
fibrillation as the first identifiable rhythm decreased from 0.85 per 1000
population in 1980 to 0.38 per 1000 in 2000, whereas the incidence of asystolic
arrest and cases of pulseless electrical activity did not decline. In a commentary,
Weisfeldt and BeckerArticle identify 3 time-sensitive phases of ventricular fibrillation–mediated
cardiac arrest (electrical, circulatory, and metabolic) and propose a 3-phase
model of cardiopulmonary resuscitation with phase-specific interventions to
treat the pathophysiology of ischemia and reperfusion as it progresses over
In this cohort study of patients with end-stage renal disease placed
on the renal transplant waiting list, Ball and colleagues found that soon
after kidney transplantation, risk of hip fracture was significantly higher
among transplant recipients than among patients who continued to undergo dialysis.
However, hip fracture risk in transplant recipients then decreased until the
estimated risk became equal approximately 630 days after transplantation.
In a previously reported study, Tamblyn and colleagues found that scores
on the Québec family medicine certification examination predicted resource
use and quality of care in the first 18 months of practice. In this study
of practice performance during the first 4 to 7 years of practice after family
medicine certification, Tamblyn and colleagues found that the relationships
between family medicine certification examination scores and practice performance
persisted and that scores achieved on licensure examinations taken at the
end of medical school were also predictive of practice performance.
"Dearborn, Michigan, has the largest Arab American community in the
United States. Since I am Jewish, I wondered what that would mean for my practice."
From "Lessons in Friendship."
Researchers at an urban and a rural midwestern medical center have each
begun to enroll 100 000 people whose DNA samples will be used to create
gene banks to make possible the identification and treatment of diseases resulting
from interactions between genes and environment.
The Patient-Physician Relationship
Results of a randomized controlled trial indicate that use of standardized
health-related quality-of-life assessments during palliative cancer chemotherapy
increases discussion of health-related quality-of-life issues and physicians'
awareness of patients' health-related quality of life.
From the Archives Journals
Rosenberg considers the molecular and genomic basis of brain aging in
this discussion of a prospective cohort study recently reported in the Archives of Neurology that evaluated whether cerebrospinal
fluid levels of tau and β-amyloid 42 proteins predict progression from
mild cognitive impairment to Alzheimer disease.
For your patients: Information about quality-of-life assessment.
This Week in JAMA. JAMA. 2002;288(23):2927. doi:10.1001/jama.288.23.2927