August 27th, 2013

Selections from Richard Lehman’s Literature Review: August 27th

CardioExchange is pleased to reprint this selection from Dr. Richard Lehman’s weekly journal review blog at Selected summaries are relevant to our audience, but we encourage members to engage with the entire blog.

Ann Intern Med  20 Aug 2013  Vol 159

BP and Mortality in U.S. Veterans with CKD (pg. 233): Following Ray Moynihan et al’s measured argument in the BMJ against labelling 11% of adults as having “chronic kidney disease,” there have been lots of responses from single interest people to the effect that this is so that we can target them for special preventive treatment, including tighter control of blood pressure. This study of US Veterans with CKD introduces some observational evidence into the debate. Lowering diastolic BP in these people below 70 is associated with higher mortality, irrespective of the systolic pressure. The best outcomes were seen with diastolics between 70 and 89, and systolics between 130 and 159 Hg. Note that last figure. Male “patients with CKD”—mostly healthy asymptomatic people—are quite OK to run a systolic BP up to 159, and not OK to run a diastolic below 70. These figures bear no relation to any targets set by tunnel-vision committees of specialists and CKD “champions,” and apply equally to those with albuminuria and those without.

JAMA  21 Aug 2013  Vol 310

Improved BP Control Associated with a Large-Scale Hypertension Program (pg. 699): A structured hypertension management programme by Kaiser Permanente in the USA achieves better BP control than usual care. Strange indeed had it been otherwise. There’s not much for NHS doctors to learn from here: keep collecting the QOF BP points.


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