Chapter 10-05: Key Clinical Trials & Publications in General Medicine

HYPERTENSION MANAGEMENT

• SPRINT. N Eng J Med 2015;373(22):2103–2116

  • - Multicenter, open-label, randomized controlled trial that randomized patients at high risk for CVD but who did not have a history of diabetes or stroke to an intensive (<120 mmHg) vs. standard (<140 mmHg) SBP target. Intensive BP control (target SBP <120 mmHg) improved CV outcomes and overall survival compared to the standard SBP goal <140 mmHg, with modest increase in the risk of some serious adverse events. Similar benefits were demonstrated in a CKD subgroup analysis (JASN 2017:28(9):2561–2563).

CHRONIC PAIN MANAGEMENT

• Pain Management With Opioids in 2019-2020. JAMA 2019;322(19):1912–1913.

  • - This paper offers guidance on the management of patients with chronic pain and currently on opioids: develop and use individualized treatment plans, do not abruptly taper opioid treatment, and consider opioid agonist therapy (e.g., buprenorphine/naloxone) if evidence of opioid use disorder.

DIET AND EXERCISE

• Association of Step Volume and Intensity With All-Cause Mortality in Older Woman. JAMA Intern Med 2019;179(8):1105–1112.

  • - Cohort study of 16,741 women with a mean age of 72 yr, measured steps per day over 7 days. Women who averaged 4,400 steps/day had significantly lower mortality rates during follow up of 4.3 yr (HR 0.75) compared with the less active women (2,700 steps/day). Mortality rates progressively decreased with increasing steps, with a plateau at 7,500 steps/day (HR 0.45).

• EPIC trial. JAMA Intern Med 2019;179(11):1479–1490.

  • - Population-based cohort study of 451,743 individuals from 10 countries in Europe who self-reported intake of soft drinks (diet and regular). Higher all-cause mortality was found among participants who consumed 2 or more glasses/day vs. <1 glass/month (HR 1.17, 95% CI, 1.11–1.22, p < 0.001). Regular and diet soda is associated with mortality, especially CV disease.

ADVANCED CARE PLANNING

• Advanced Directives and Outcomes of Surrogate Decision Making Before Death. N Engl J Med 2010;362(13):1211–1218.

  • - This study used data from survey proxies in the Health and Retirement Study involving adults ≥60 yr who died between 2000 and 2006 to determine the prevalence of the need for decision making and lost decision-making capacity at the end of life. Many patients needed decision making near the end of life when most lacked the capacity to do so. Patients who had prepared advanced directives received care associated with their preferences, supporting the continued use of advanced directives.

PREVENTATIVE HEALTH

• ASPREE. N Engl J Med 2018;379(16):1–10.

  • - Multicenter, double-blind, randomized placebo controlled trial that randomized healthy, community-dwelling older adults (age ≥70 yr or ≥65 yr in Hispanic or black patients in the United States) without a history of CVD, cerebrovascular disease, dementia, or any other chronic condition that would likely limit survival to less than 5 yr) to receive either aspirin 100 mg daily or placebo and followed prospectively for all-cause death, dementia, ...