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This Week in JAMA
JAMA. 2003;289:2027.
Initial Antihypertensive Therapy and CVD Outcomes
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 colleagues (SEE ARTICLE) 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 Rennie (SEE ARTICLE) discuss ethical implications of early termination of clinical trials for commercial reasons.
Lifestyle Modifications and Blood Pressure Control
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, (SEE 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, Pickering (SEE ARTICLE) discusses why combining lifestyle interventions may not have an additive antihypertensive effect.
CSF  -Amyloid1-42 and Tau Proteins as Biomarkers for AD
The usefulness of cerebrospinal fluid (CSF)  -amyloid1-42 and tau protein levels as biomarkers for Alzhheimer disease (AD) has been uncertain. In this comparison of baseline CSF -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 -amyloid1-42 levels were significantly lower in patients with AD and levels of CSF tau protein were significantly higher.
(SEE ARTICLE)
New JAMA Section
TRANSLATIONAL MEDICAL RESEARCH
Mechanical Ventilation and Epithelial Cell Apoptosis
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 colleagues (SEE ARTICLE) 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 dysfunction (SEE ARTICLE) .
A Piece of My Mind
"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."
(SEE ARTICLE)
Contempo Updates
Long QT syndrome: clinical features, course, diagnosis, and treatment.
(SEE ARTICLE)
Medical News & Perspectives
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.
(SEE ARTICLE)
Withdrawal of Dialysis
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.
(SEE ARTICLE)
CLINICIAN'S CORNER
QT Interval and Medication Use
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.
(SEE ARTICLE)
Torture of Detainees in Mexico
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 of torture.
(SEE ARTICLE)
JAMA Patient Page
For your patients: A primer on electrocardiograms.
(SEE ARTICLE)
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