The Controlled Onset Verapamil Investigation of Cardiovascular End Points
(CONVINCE) study, a randomized trial among adults with hypertension and 1
or more additional risk factors for cardiovascular disease (CVD), was designed
to assess whether initial antihypertensive therapy with controlled-onset extended
release (COER) verapamil is equivalent to standard therapy with either atenolol
or hydrochlorothiazide for prevention of CVD during 5 years of follow-up.
The study was stopped early by the sponsor for commercial reasons prior to
unblinding the results. Black and colleaguesArticle report
that when the study was stopped after a mean of 3 years of follow-up, 364
first CVD-related events (stroke, myocardial infarction, or CVD-related death)
had occurred in the COER verapamil group, and 365 events had occurred in the
atenolol or hydrochlorothiazide group. The upper bound of the 95% confidence
interval of the hazard ratio, however, exceeded the prespecified equivalence
bound, and therefore the trial did not demonstrate equivalence. In an editorial,
Psaty and RennieArticle discuss ethical implications
of early termination of clinical trials for commercial reasons.
Lifestyle modifications, including weight loss, sodium reduction, increased
physical activity, and limited alcohol intake, are recommended for nonhypertensive
individuals with above-optimal blood pressure (BP) and as initial therapy
for stage 1 hypertension. In the PREMIER trial,Article adults
with above-optimal BP, including stage 1 hypertension, who were not taking
antihypertensive medication were randomly assigned to receive a behavioral
intervention that implemented established lifestyle modification recommendations,
the established intervention plus the Dietary Approaches to Stop Hypertension
(DASH) diet, or a 1-time advice only control intervention. Blood pressure
declined in all study groups over 6 months. Reductions in systolic and diastolic
BP were significantly greater in both behavioral intervention groups compared
with the advice only group. The mean net reduction in systolic BP was 3.7
mm Hg in the established intervention group and 4.3 mm Hg in the established
intervention plus DASH diet group. In an editorial, PickeringArticle discusses
why combining lifestyle interventions may not have an additive antihypertensive
The usefulness of cerebrospinal fluid (CSF) β-amyloid1-42 and tau protein levels as biomarkers for Alzhheimer disease (AD) has
been uncertain. In this comparison of baseline CSF β-amyloid1-42 and tau protein levels in patients with AD and control participants
enrolled in a longitudinal, prospective study of AD, Sunderland and colleagues
found that CSF β-amyloid1-42 levels were significantly lower
in patients with AD and levels of CSF tau protein were significantly higher.
The most common cause of death among patients with acute respiratory
distress syndrome is dysfunction of organs other than the lung—a syndrome
called multiple organ dysfunction. In this series of experimental models,
the first report in a new JAMA section on translational medical research,
Imai and colleaguesArticle observed that an injurious
ventilatory strategy increased epithelial cell apoptosis in the kidney and
small intestine and was associated with elevated biochemical markers of renal
"I sense what she wants. She needs a tiny gift of hope, even if it lasts
just an infinitesimal fraction of time, so she can try to accept the unacceptable."
From "One More Time."
Long QT syndrome: clinical features, course, diagnosis, and treatment.
Growing numbers of college students are seeking help for depression
and other psychiatric disorders, but campus mental health services have not
kept pace with the increased demand.
Excerpts from interviews of family members and physicians of a 78-year-old
man with end-stage renal disease and dementia illustrate guidelines on decision
making for discontinuation of dialysis.
A review of available data on measurement of the QT interval and factors
that prolong the QT interval, and recommendations for monitoring patients
receiving QT-prolonging medications.
A survey of federal and state forensic physicians in Mexico indicates
that torture and ill treatment of detainees is a serious problem. Most respondents
reported major obstacles that interfere with efforts to document evidence
For your patients: A primer on electrocardiograms.
This Week in JAMA . JAMA. 2003;289(16):2027. doi:10.1001/jama.289.16.2027