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Community pharmacy interventions for health promotion: effects on professional practice and health outcomes.
CONCLUSIONS: Health-promotion interventions in the community pharmacy context probably improve pharmacy workers' behaviour and probably have a slight beneficial effect on health-related behaviour, intermediate clinical outcomes, and quality of life for pharmacy users. Such interventions are likely to be cost-effective and the effects are seen across a range of clinical conditions and health-related behaviours. Nevertheless the magnitude of the effects varies between conditions, and more effective interventions might be developed if greater consideration were given to the theoretical basis of the intervention and mechanisms...
Source: Cochrane Database of Systematic Reviews - December 5, 2019 Category: General Medicine Authors: Steed L, Sohanpal R, Todd A, Madurasinghe VW, Rivas C, Edwards EA, Summerbell CD, Taylor SJ, Walton RT Tags: Cochrane Database Syst Rev Source Type: research

Pharmacological interventions for painful sickle cell vaso-occlusive crises in adults.
CONCLUSIONS: This review identified only nine studies, with insufficient data for all pharmacological interventions for analysis. The available evidence is very uncertain regarding the efficacy or harm from pharmacological interventions used to treat pain related to sickle cell VOC in adults. This area could benefit most from more high quality, certain evidence, as well as the establishment of suitable registries which record interventions and outcomes for this group of people. PMID: 31742673 [PubMed - in process]
Source: Cochrane Database of Systematic Reviews - November 13, 2019 Category: General Medicine Authors: Cooper TE, Hambleton IR, Ballas SK, Johnston BA, Wiffen PJ Tags: Cochrane Database Syst Rev Source Type: research

Thrombolytic therapy for pulmonary embolism.
CONCLUSIONS: Low-quality evidence suggests that thrombolytics reduce death following acute pulmonary embolism compared with heparin. The included studies used a variety of thrombolytic drugs. Thrombolytic therapy may be helpful in reducing the recurrence of pulmonary emboli but may cause major and minor haemorrhagic events and stroke. More high-quality, blinded randomised controlled trials assessing safety and cost-effectiveness of therapies for pulmonary embolism are required. PMID: 30560579 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - December 18, 2018 Category: General Medicine Authors: Hao Q, Dong BR, Yue J, Wu T, Liu GJ Tags: Cochrane Database Syst Rev Source Type: research

First-line drugs inhibiting the renin angiotensin system versus other first-line antihypertensive drug classes for hypertension.
CONCLUSIONS: All-cause death is similar for first-line RAS inhibitors and first-line CCBs, thiazides and beta-blockers. There are, however, differences for some morbidity outcomes. First-line thiazides caused less HF and stroke than first-line RAS inhibitors. First-line CCBs increased HF but decreased stroke compared to first-line RAS inhibitors. The magnitude of the increase in HF exceeded the decrease in stroke. Low-quality evidence suggests that first-line RAS inhibitors reduced stroke and total CV events compared to first-line beta-blockers. The small differences in effect on blood pressure between the different classe...
Source: Cochrane Database of Systematic Reviews - November 14, 2018 Category: General Medicine Authors: Chen YJ, Li LJ, Tang WL, Song JY, Qiu R, Li Q, Xue H, Wright JM Tags: Cochrane Database Syst Rev Source Type: research

Acupuncture for hypertension.
CONCLUSIONS: At present, there is no evidence for the sustained BP lowering effect of acupuncture that is required for the management of chronically elevated BP. The short-term effects of acupuncture are uncertain due to the very low quality of evidence. The larger effect shown in non-sham acupuncture controlled trials most likely reflects bias and is not a true effect. Future RCTs must use sham acupuncture controls and assess whether there is a BP lowering effect of acupuncture that lasts at least seven days. PMID: 30480757 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - November 14, 2018 Category: General Medicine Authors: Yang J, Chen J, Yang M, Yu S, Ying L, Liu GJ, Ren YL, Wright JM, Liang FR Tags: Cochrane Database Syst Rev Source Type: research

Blood pressure targets for the treatment of people with hypertension and cardiovascular disease.
CONCLUSIONS: We found no evidence of a difference in total mortality, serious adverse events, or total cardiovascular events between people with hypertension and cardiovascular disease treated to a lower or to a standard blood pressure target. This suggests that no net health benefit is derived from a lower systolic blood pressure target. We found very limited evidence on adverse events, which led to high uncertainty. At present, evidence is insufficient to justify lower blood pressure targets (≤ 135/85 mmHg) in people with hypertension and established cardiovascular disease. More trials are needed to examine this topic....
Source: Cochrane Database of Systematic Reviews - July 20, 2018 Category: General Medicine Authors: Saiz LC, Gorricho J, Garjón J, Celaya MC, Erviti J, Leache L Tags: Cochrane Database Syst Rev Source Type: research

Blood pressure-lowering treatment for preventing recurrent stroke, major vascular events, and dementia in patients with a history of stroke or transient ischaemic attack.
CONCLUSIONS: Our results support the use of BPLDs in people with stroke or TIA for reducing the risk of recurrent stroke. Current evidence is primarily derived from trials studying an ACE inhibitor or a diuretic. No definite conclusions can be drawn from current evidence regarding an optimal systolic blood pressure target after stroke or TIA. PMID: 30024023 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - July 19, 2018 Category: General Medicine Authors: Zonneveld TP, Richard E, Vergouwen MD, Nederkoorn PJ, de Haan R, Roos YB, Kruyt ND Tags: Cochrane Database Syst Rev Source Type: research

First-line drugs for hypertension.
CONCLUSIONS: First-line low-dose thiazides reduced all morbidity and mortality outcomes in adult patients with moderate to severe primary hypertension. First-line ACE inhibitors and calcium channel blockers may be similarly effective, but the evidence was of lower quality. First-line high-dose thiazides and first-line beta-blockers were inferior to first-line low-dose thiazides. PMID: 29667175 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - April 18, 2018 Category: General Medicine Authors: Wright JM, Musini VM, Gill R Tags: Cochrane Database Syst Rev Source Type: research

Epidural therapy for the treatment of severe pre-eclampsia in non labouring women.
CONCLUSIONS: Currently, there is insufficient evidence from randomised controlled trials to evaluate the effectiveness, safety or cost of using epidural therapy for treating severe pre-eclampsia in non-labouring women.High-quality randomised controlled trials are needed to evaluate the use of epidural agents as therapy for treatment of severe pre-eclampsia. The rationale for the use of epidural is well-founded. However there is insufficient evidence from randomised controlled trials to show that the effect of epidural translates into improved maternal and fetal outcomes. Thus, there is a need for larger, well-designed stud...
Source: Cochrane Database of Systematic Reviews - November 28, 2017 Category: General Medicine Authors: Ray A, Ray S Tags: Cochrane Database Syst Rev Source Type: research

Blood pressure targets for the treatment of people with hypertension and cardiovascular disease.
CONCLUSIONS: No evidence of a difference in total mortality and serious adverse events was found between treating to a lower or to a standard blood pressure target in people with hypertension and cardiovascular disease. This suggests no net health benefit from a lower systolic blood pressure target despite the small absolute reduction in total cardiovascular serious adverse events. There was very limited evidence on adverse events, which lead to high uncertainty. At present there is insufficient evidence to justify lower blood pressure targets (≤ 135/85 mmHg) in people with hypertension and established cardiovascular dis...
Source: Cochrane Database of Systematic Reviews - October 11, 2017 Category: General Medicine Authors: Saiz LC, Gorricho J, Garjón J, Celaya MC, Muruzábal L, Malón MDM, Montoya R, López A Tags: Cochrane Database Syst Rev Source Type: research

Pharmacotherapy for hypertension in adults aged 18 to 59 years.
CONCLUSIONS: Antihypertensive drugs used to treat predominantly healthy adults aged 18 to 59 years with mild to moderate primary hypertension have a small absolute effect to reduce cardiovascular mortality and morbidity primarily due to reduction in cerebrovascular mortality and morbidity. All-cause mortality and coronary heart disease were not reduced. There is lack of good evidence on withdrawal due to adverse events. Future trials in this age group should be at least 10 years in duration and should compare different first-line drug classes and strategies. PMID: 28813123 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - August 16, 2017 Category: General Medicine Authors: Musini VM, Gueyffier F, Puil L, Salzwedel DM, Wright JM Tags: Cochrane Database Syst Rev Source Type: research

Blood pressure targets for hypertension in older adults.
CONCLUSIONS: At the present time there is insufficient evidence to know whether a higher BP target (less than150 to 160/95 to 105 mmHg) or a lower BP target (less than 140/90 mmHg) is better for older adults with high BP. Additional good-quality trials assessing BP targets in this population are needed. PMID: 28787537 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - August 8, 2017 Category: General Medicine Authors: Garrison SR, Kolber MR, Korownyk CS, McCracken RK, Heran BS, Allan GM Tags: Cochrane Database Syst Rev Source Type: research

Shared care across the interface between primary and specialty care in management of long term conditions.
CONCLUSIONS: This review suggests that shared care improves depression outcomes and probably has mixed or limited effects on other outcomes. Methodological shortcomings, particularly inadequate length of follow-up, may account in part for these limited effects. Review findings support the growing evidence base for shared care in the management of depression, particularly stepped care models of shared care. Shared care interventions for other conditions should be developed within research settings, with account taken of the complexity of such interventions and awareness of the need to carry out longer studies to test effect...
Source: Cochrane Database of Systematic Reviews - February 22, 2017 Category: Journals (General) Authors: Smith SM, Cousins G, Clyne B, Allwright S, O'Dowd T Tags: Cochrane Database Syst Rev Source Type: research

Renal denervation for resistant hypertension.
CONCLUSIONS: In patients with resistant hypertension, there is low quality evidence that renal denervation does not change major cardiovascular events, and renal function. There was moderate quality evidence that it does not change blood pressure and and low quality evidence that it caused an increaseof bradycardia episodes. Future trials measuring patient-centred instead of surrogate outcomes, with longer follow-up periods, larger sample size and more standardized procedural methods are necessary to clarify the utility of this procedure in this population. PMID: 28220472 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - February 20, 2017 Category: Journals (General) Authors: Coppolino G, Pisano A, Rivoli L, Bolignano D Tags: Cochrane Database Syst Rev Source Type: research

Beta-blockers for hypertension.
CONCLUSIONS: Most outcome RCTs on beta-blockers as initial therapy for hypertension have high risk of bias. Atenolol was the beta-blocker most used. Current evidence suggests that initiating treatment of hypertension with beta-blockers leads to modest CVD reductions and little or no effects on mortality. These beta-blocker effects are inferior to those of other antihypertensive drugs. Further research should be of high quality and should explore whether there are differences between different subtypes of beta-blockers or whether beta-blockers have differential effects on younger and older people. PMID: 28107561 [PubMe...
Source: Cochrane Database of Systematic Reviews - January 19, 2017 Category: Journals (General) Authors: Wiysonge CS, Bradley HA, Volmink J, Mayosi BM, Opie LH Tags: Cochrane Database Syst Rev Source Type: research

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