Most commonly encountered landmark studies

Landmark trials and studies that changed internal medicine practice

SPRINT (2015)

Blood pressure control

When this study's results came out, the New York Times sent out a "breaking news" email (usually reserved for economic or political calamities) to its subscribers.

This study looked at intensive (systolic BP <120) vs standard blood (sBP<140) pressure control in nondiabetic patients over the age of 50. The primary outcome was cardiovascular events, such as MI, ACS, CVA, CHF, CVS-related deaths. The study was terminated more than a year early because it had found convincing evidence for the benefits of tighter blood pressure targets. Approximately a 25% reduction in annual all-cause mortality was found for the group that tighter blood pressure targets. The tigher control came at the expense of using, on average, one more antihypertensive agent in this group. Comaprisons to the ACCORD group's study of tighter BP control (<120) in diabetics are inevitable. In that study, no statistically signficiant benefit was found for tighter control.

EMPA-REG (2015)

Diabetic control

Reportedly, when the results of this trial were presented to a few thousand endocrinologists gathered in Stockholm, the audience erupted in cheers and applaud. The study, known as "Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes", looked at 7020 type II diabetics who were given either empagliflozin (an SGLT2 inhibitor) or placebo. The study found a 38% reduction in cardiovascular death in the empagliflozin group.


Heart failure

Formally known as "Angiotensin–Neprilysin Inhibition versus Enalapril in Heart Failure," this study was stopped early because of the overwhelming benefit of the treatment. This study introduced us to Entresto, a combination treatment for heart failure.

ACCORD (2008)

Diabetic control

Formally known as "Effects of Intensive Glucose Lowering in Type 2 Diabetes," this study was stopped early because of the harm it caused to patients receiving intensive blood glucose control. The study looked at the effects of intensive vs standard BG control in high-risk type II diabetic patients. The primary outcomes were nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes. Mortality and hypoglycemia requiring assistance were significantly more common in the group receiving intensive therapy.

TRICC (1999)

Blood transfusions

The long title is "A multi-center, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group." This is perhaps one of the most influential studies in internal medicine and critical care. Its conclusions drive many of the guidelines we use to decide on transfusions. Several later studies did in fact substantiate the results of this study. In brief, this RCT looked at liberal (hgb <100 g/L) versus restrictive (hgb <70 g/L) in 838 critically ill patients. It found no difference in survival between the two groups.