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Update in General Internal Medicine
- John V.L. Sheffield, MD; and
- Eric B. Larson, MD, MPH
- From Harborview Medical Center and University of Washington Medical Center, Seattle, Washington.
2001–2002 Series: Update Sessions from ACP–ASIM's 2001 Annual Session
Margaret Ring Gillock, Editor; David Cramer, MD, Co-Editor; and Paul T. Kefalides, MD, Co-Editor
This year's Update in General Internal Medicine spans a wide area but fits into a framework of themes we chose to emphasize: hypertension, hormone replacement therapy, anticoagulation, atrial fibrillation, chronic infectious diseases, hospital care, and prevention. These articles were compiled with the help of our colleagues in the Department of Medicine at the University of Washington, Seattle, Washington, and the editors of ACP Journal Club.
Hypertension
These days, the most important studies of hypertension report event end points, not reduction in blood pressure. We discuss a study that compared diuretics with α-blockers, a study describing the use of angiotensin-converting enzyme (ACE) inhibitors for diabetic patients, and a few papers that examine the role of calcium-channel blockers.
Diuretic Was Superior to α-Blocker for Initial Treatment
The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) is a large trial comparing multiple agents for the initial treatment of hypertension. This first report described 24 335 hypertensive patients older than 55 years of age [mean age, 67 years] who had at least one risk factor for coronary artery disease. Entry criteria were 1) a systolic blood pressure greater than 140 mm Hg or a diastolic blood pressure greater than 90 mm Hg or 2) current anti-hypertensive treatment. Patients were randomly assigned to receive doxazosin or chlorthalidone. Both groups had similar initial blood pressure. Atherosclerotic cardiovascular disease and type 2 diabetes were the most common cardiac risk factors in the study sample.
This study was terminated early on the basis of a recommendation of the safety and monitoring board. Although the primary outcomes of fatal coronary artery disease or nonfatal myocardial infarction and all-cause mortality were the same for the two groups, the 4-year rate of combined cardiovascular …
