January 2003
ISHIB Responds to ALLHAT Data 
The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack (ALLHAT) study, reported in the December 18, 2002 issue of the Journal of the American Medical Association (JAMA), has important messages for the International Society on Hypertension in Blacks because of the enormous number of minorities (more than 11,000 Blacks and more than 6,000 Hispanics) included in the study. In addition, all study participants (33,357) had high blood pressure (hypertension) and more than one third (more than 11,000) had diabetes. High blood pressure occurs 1.5 times more often in Blacks as compared to Whites. (About 1 of every 3 adult Black Americans has high blood pressure.) Diabetes also occurs disproportionately in both Blacks and Hispanics.
The study was sponsored by the National Heart, Lung, and Blood Institute (NHLBI) and is the largest clinical study to date to compare the effectiveness of medications to treat high blood pressure. The average participant follow-up was approximately 5 years.
ALLHAT documented that traditional diuretics [compared with newer medications represented by one type of calcium antagonist (amlodipine) or an ACE inhibitor (lisinopril)] were effective at lowering blood pressure and preventing several forms of cardiovascular disease. Blood pressure control was not equal across treatment groups. The occurrence of coronary heart disease death and nonfatal heart attack (the primary study endpoint) were nearly identical in the groups treated primarily with the diuretic versus the calcium antagonist or the ACE inhibitor. All-cause mortality did not differ among the treatment groups. Diuretic-based therapy was superior to the calcium antagonist in preventing heart failure and also was superior to the ACE inhibitor at lowering blood pressure and preventing stroke, combined cardiovascular disease, and possibly heart failure.
An important note is that more than one blood pressure drug (used at the same time) was usually needed to control blood pressure to less than 140/90 mm Hg. A diuretic should be included, whenever possible, in all multidrug regimens used to control blood pressure. Individuals currently taking antihypertensive medication should not change or discontinue their medications without first consulting their physician. Although these medications were compared against one another, they will frequently need to be used in combination to control blood pressure to desired levels. Future ALLHAT publications will address several subgroup comparisons (age, sex, black versus nonblack, diabetic versus nondiabetic, etc) in more detail.
A subset of more than 10,000 ALLHAT participants with high blood pressure were eligible for a substudy if they also had certain elevated levels of blood lipids. Management consisted of either usual lipid-lowering treatment or treatment with a type of cholesterol-lowering drug known as a statin (represented here by pravastatin, 40 mg daily). After 4 years, both treatment programs significantly lowered cholesterol levels: by 7.6% in the usual care group and by 17.2% in the pravastatin group. Although the lipid levels were lowered more in the pravastatin group, these differences were not associated with any significant advantages from the usual care group with regard to death rate or rates of coronary heart disease or stroke.
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Prescriptions for Health show topics for January/February:
1/15: Depression
1/29: Lupus
2/5: Cardiovascular Disease
2/12: Cardiovascular Disease and HIV Infection
2/19: Children and Cardiovascular Disease
2/26: Stroke
ISHIB2003, World Congress on Cardiovascular Health: Preventing the Global Pandemic in Developing Countries, convenes June 22-25 in Accra, Ghana. ISHIB2003 will be an important meeting for healthcare practitioners and researchers interested in reducing the global burden of cardiovascular disease, and ISHIB is committed to making the congress accessible and affordable to everyone. Recently, ISHIB negotiated further discounts on travel packages to Ghana; visit the conference website for revised pricing information.
An abstract presented at ISHIB2002 in Miami attracted the attention of a reporter from Internal Medicine News. The abstract, "An Examination of Spiritual Fitness and Spirituality in Health Care," described a project assessing the effect of "spiritual fitness" on health; after speaking with author Jacqueline Moore-Carter and her professor Clifton Addison, PhD, the reporter was so intrigued he invited them to submit a guest editorial for his newspaper.
This editorial was published in the December 15, 2002 edition of Internal Medicine News. It discusses the importance of spirituality and religious commitment to improve health outcomes, particularly in Black patients, since a 2000 survey found that 95% of African Americans consider religion and faith important in their lives.
Jacqueline Moore-Carter and Clifton Addison, PhD, of Jackson State University
ISHIB is proud that its meetings can serve as a link between young investigators and the larger healthcare community. Remember that the deadline for submitting abstracts for ISHIB2003 is 14 February 2003.
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Editorial calendar for Volume 13:
Volume 13(1), January 2003: "Diabetes Across the Generations"
Volume 13(2), April 2003: "Cardiovascular Disease"
Volume 13(3), July 2003: "Mental Health"
Volume 13(4), October 2003: "Community- and State-based Initiatives on Cardiovascular Disease"
In 2001, Dr. Mahfouz El-Shahaway became the first lifetime member of ISHIB. Since then, other dedicated professionals have followed his lead and joined the lifetime membership program. A lifetime membership may be had by paying 3 annual installments of $834 or a single payment of $2500. ISHIB is pleased to acknowledge the following lifetime members:
Errol D. Crook, MD
Janice G. Douglas, MD
Mahfouz El-Shahaway (founding lifetime member)
John M. Flack, MD, MPH
Eddie L. Greene, MD
James D. Nelson, MD
Keith C. Norris, MD
The ISHIB staff made the 2002 holiday season a little happier for some very special boys and girls. In lieu of a holiday party, the staff elected to instead spend the money on toys for needy children. On December 23, ISHIB employees delivered wrapped presents to the Southwest Hospital and Medical Center, which serves a predominantly Black population in Atlanta. Marie Cameron, President and CEO of Southwest thanked the staff for their generosity.
Above left, from left: Melanie Cockfield, Darren Baylor, Terry Jackson, Regina Epps-Johnson, Ronnie Henry.
Above right, clockwise from left: Terry Jackson, Kermit Payne, Darren Baylor, Melanie Cockfield, Ronnie Henry, Regina Epps-Johnson; center: Marie Cameron.
Nicolas P. Fiavey, MD, MPH; Kimberly France, RPh; Barbara Hemingway; Hope Landrine, PhD; Jules Ndjebet, MD;
Welton O'Neal, Jr.; Jerome W. Wright, MSW, PhD.