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In This Issue of Archives of Internal Medicine
Arch Intern Med. 2001;161:639.
The Role of Angiotensin Receptor Blockers in the Management of Chronic
Heart Failure
The renin-angiotensin-aldosterone system plays a major role in the development
and progression of heart failure. The review by Jamali et al of major outcome
trials explores the rationale for and clinical experience with the use of
angiotensin-converting enzyme inhibitors and angiotensin receptor antagonist,
alone or in combination, in patients with heart failure.
(SEE ARTICLE)
How Much Information About Adverse Effects of Medication Do Patients
Want From Physicians?
Ziegler et al questioned 2500 individuals about whether or not they
wished to be told about medication-induced adverse effects. The desire for
maximum information was positively correlated with lower educational levels
and previous experience with adverse effects.
(SEE ARTICLE)
Effects of Reduced Sodium Intake on Hypertension Control in Older Individuals
Sodium reduction is widely advocated to reduce blood pressure and control
hypertension in the elderly, but empiric evidence on its efficacy is scarce.
In this article by Appel et al on a large, randomized trial of a diverse group
of individuals with hypertension aged 60 to 80 years, those who made the greatest
reduction in sodium intake also were the most likely to have controlled blood
pressure, many without medication. Reduced sodium intake is a broadly effective
nonpharmacologic therapy to lower blood pressure and control hypertension
in older individuals.
(SEE ARTICLE)
Randomized Trial of the Effect of Folic Acid Supplementation on Serum
Homocysteine Levels
Lowering serum homocysteine with folic acid purportedly reduces mortality
from ischemic heart disease, although direct evidence of this has not yet
been confirmed in clinical trials.
The minimum dose of folic acid needed to effect the maximum reduction
in serum homomocysteine is not established. The placebo-controlled, randomized
trial by Wald and colleagues documents 151 patients with ischemic heart disease
were who randomized to 1 of 5 doses of folic acid or placebo.
They found that homocysteine levels decreased with increased intake
of folic acid; the maximum effect was seen in those taking doses of up to
0.8 mg daily. Based on these results and the established association between
homocysteine levels and ischemic heart disease, mortality from heart disease
could be reduced by 15% with this therapy. Since the current US government–mandated
level of fortification is 0.14 mg of folic acid per 100 g of cereal grain,
approximately 0.1 mg/d, substantial increases in this amount are needed to
realize the full potential benefits of folic acid intake in reducing ischemic
heart disease.
(SEE ARTICLE)
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