No blood pressure lowering agents prolong survival in diabetes and kidney disease, review shows

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No blood pressure lowering agents used either alone or in combination prolong survival in adults with diabetes and kidney disease, a meta-analysis published in the Lancet has found.

Researchers analysed 157 studies comparing blood pressure lowering agents in a total of 43 256 patients with diabetic kidney disease, mostly type 2 diabetes and chronic kidney disease

NICE: This month in Eyes on Evidence

nice_nhs_evidenceIssue 69
January 2015

 

Pharmacy-based screening for cardiovascular risk
A systematic review suggests that pharmacy-based screening for cardiovascular risk factors may be possible. However, many people do not act on the advice to visit their GP, and the effect of screening on new diagnoses has not been robustly shown.

Self-management of hypertension in people at high risk of cardiovascular events
An open-label randomised controlled trial finds that people with hypertension who self-monitor their blood pressure and up-titrate their antihypertensive medication experience a greater reduction in systolic blood pressure than people who manage hypertension with usual care.

Mental health after stopping smoking
A meta-analysis finds that stopping smoking is associated with reductions in anxiety, depression and stress, and improvements in quality of life and mood.

Alpha-blockers for expulsion of ureteral stones
A Cochrane review reports that alpha-blockers are more effective at expelling ureteral stones less than 10 mm in diameter than standard therapy or calcium channel blockers.

Haemoglobin thresholds for blood transfusion
Two meta-analyses report that restricting transfusion of red blood cells to people with a haemoglobin level of either less than 7.0 g/dl or 6.4 g/dl to 9.7 g/dl reduces mortality and serious infection, but does not significantly affect the overall risk of infection.

Evidence Updates
NICE has recently published Evidence Updates on:

  • Spasticity in children and young people with non-progressive brain disorders
  • Ectopic pregnancy and miscarriage
  • Hyperphosphataemia in chronic kidney disease

Eyes on Evidence: Issue 38, June 2012

 People who are admitted to hospital with a psychotic disorder may have their illness misclassified. Diagnosis should be reassessed periodically to ensure that the most appropriate interventions are being used.

There may be differences in mortality risk between individual antipsychotic agents used to treat people with dementia. Patients should be monitored for adverse events in the acute treatment period, and periodic attempts to discontinue medication should be made.

Caution is urged over the long-term use of antiplatelets in people with chronic kidney disease. Treating 1000 patients with oral antiplatelet therapy for a year may prevent nine heart attacks, but this needs to be balanced against an increased risk of bleeding.
Pregnant women may experience some benefit from using relaxation techniques during labour, in relation to reduced pain, increased satisfaction and improved clinical outcomes. However, the available evidence is insufficient to make clinical recommendations.

Antimuscarinic drugs for urinary incontinence in women 

There is no strong evidence of a clinically important difference in efficacy between antimuscarinic drugs. The choice of antimuscarinic drug for an individual woman is likely to depend on tolerability, patient preference, and cost.

Details of a new resource available via NHS Evidence search.

Cochrane quality and productivity topics

Potential disinvestment opportunities highlighted this month are:
  • Aminosalicylates for induction of remission or response in Crohn’s disease.
  • Oral budesonide for induction of remission in ulcerative colitis.

Evidence Updates

This month NHS Evidence has published three Evidence Updates.
  • Improving outcomes in head and neck cancers.
  • Familial breast cancer.
  • Sedation in children and young people.