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Interventions for deliberately altering blood pressure in acute stroke.
CONCLUSIONS: There is insufficient evidence that lowering blood pressure during the acute phase of stroke improves functional outcome. It is reasonable to withhold blood pressure-lowering drugs until patients are medically and neurologically stable, and have suitable oral or enteral access, after which drugs can than be reintroduced. In people with acute stroke, CCBs, ACEI, ARA, beta blockers and NO donors each lower blood pressure while phenylephrine probably increases blood pressure. Further trials are needed to identify which people are most likely to benefit from early treatment, in particular whether treatment started...
Source: Cochrane Database of Systematic Reviews - October 28, 2014 Category: Journals (General) Authors: Bath PM, Krishnan K Tags: Cochrane Database Syst Rev Source Type: research

Calcium antagonists for acute ischemic stroke.
CONCLUSIONS: We found no evidence to support the use of calcium antagonists in people with acute ischemic stroke. PMID: 30758052 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - February 13, 2019 Category: General Medicine Authors: Zhang J, Liu J, Li D, Zhang C, Liu M 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: We found predominantly moderate quality evidence that all-cause mortality is similar when first-line RAS inhibitors are compared to other first-line antihypertensive agents. First-line thiazides caused less HF and stroke than first-line RAS inhibitors. The quality of the evidence comparing first-line beta-blockers and first-line RAS inhibitors was low and the lower risk of total CV events and stroke seen with RAS inhibitors may change with the publication of additional trials. Compared with first-line CCBs, first-line RAS inhibitors reduced HF but increased stroke. The magnitude of the reduction in HF exceeded...
Source: Cochrane Database of Systematic Reviews - January 11, 2015 Category: Journals (General) Authors: Xue H, Lu Z, Tang WL, Pang LW, Wang GM, Wong GW, Wright JM 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

Phosphate binders for preventing and treating chronic kidney disease-mineral and bone disorder (CKD-MBD).
CONCLUSIONS: In studies of adults with CKD G5D treated with dialysis, sevelamer may lower death (all causes) compared to calcium-based binders and incur less treatment-related hypercalcaemia, while we found no clinically important benefits of any phosphate binder on cardiovascular death, myocardial infarction, stroke, fracture or coronary artery calcification. The effects of binders on patient-important outcomes compared to placebo are uncertain. In patients with CKD G2 to G5, the effects of sevelamer, lanthanum, and iron-based phosphate binders on cardiovascular, vascular calcification, and bone outcomes compared to place...
Source: Cochrane Database of Systematic Reviews - August 22, 2018 Category: General Medicine Authors: Ruospo M, Palmer SC, Natale P, Craig JC, Vecchio M, Elder GJ, Strippoli GF Tags: Cochrane Database Syst Rev Source Type: research

First-line diuretics versus other classes of antihypertensive drugs for hypertension
CONCLUSIONS: When used as first-line agents for the treatment of hypertension, thiazides and thiazide-like drugs likely do not change total mortality and likely decrease some morbidity outcomes such as cardiovascular events and withdrawals due to adverse effects, when compared to beta-blockers, calcium channel blockers, ACE inhibitors, and alpha-blockers.PMID:37439548 | DOI:10.1002/14651858.CD008161.pub3
Source: Cochrane Database of Systematic Reviews - July 13, 2023 Category: General Medicine Authors: Marcia Reinhart Lorri Puil Douglas M Salzwedel James M Wright Source Type: research

Calcium channel blockers versus other classes of drugs for hypertension
CONCLUSIONS: For the treatment of hypertension, there is moderate certainty evidence that diuretics reduce major cardiovascular events and congestive heart failure more than CCBs. There is low to moderate certainty evidence that CCBs probably reduce major cardiovascular events more than beta-blockers. There is low to moderate certainty evidence that CCBs reduced stroke when compared to angiotensin-converting enzyme (ACE) inhibitors and reduced myocardial infarction when compared to angiotensin receptor blockers (ARBs), but increased congestive heart failure when compared to ACE inhibitors and ARBs. Many of the differences ...
Source: Cochrane Database of Systematic Reviews - October 17, 2021 Category: General Medicine Authors: Jiaying Zhu Ning Chen Muke Zhou Jian Guo Cairong Zhu Jie Zhou Mengmeng Ma Li He 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

Vitamin D and vitamin D analogues for preventing fractures in post-menopausal women and older men.
CONCLUSIONS: Vitamin D alone is unlikely to prevent fractures in the doses and formulations tested so far in older people. Supplements of vitamin D and calcium may prevent hip or any type of fracture. There was a small but significant increase in gastrointestinal symptoms and renal disease associated with vitamin D and calcium. This review found that there was no increased risk of death from taking calcium and vitamin D. PMID: 24729336 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - April 14, 2014 Category: Journals (General) Authors: Avenell A, Mak JC, O'Connell D Tags: Cochrane Database Syst Rev Source Type: research

Vitamin D supplementation for sickle cell disease.
CONCLUSIONS: We included only one low-quality clinical study which had a high risk of bias with regards to incomplete outcome data. Therefore, we consider that the evidence is not of sufficient quality to guide clinical practice. Until further evidence becomes available, clinicians should consider the relevant existing guidelines for vitamin D supplementation (e.g. the Endocrine Society Clinical Practice Guidelines) and dietary reference intakes for calcium and vitamin D (e.g. from the USA Institute of Medicine). Evidence of vitamin D supplementation in sickle cell disease from high quality studies is needed. Well-designed...
Source: Cochrane Database of Systematic Reviews - January 19, 2017 Category: Journals (General) Authors: Soe HH, Abas AB, Than NN, Ni H, Singh J, Said AR, Osunkwo I 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

Potassium binders for chronic hyperkalaemia in people with chronic kidney disease.
CONCLUSIONS: Evidence supporting clinical decision-making for different potassium binders to treat chronic hyperkalaemia in adults with CKD is of low certainty; no studies were identified in children. Available studies have not been designed to measure treatment effects on clinical outcomes such as cardiac arrhythmias or major GI symptoms. This review suggests the need for a large, adequately powered study of potassium binders versus placebo that assesses clinical outcomes of relevance to patients, clinicians and policy-makers. This data could be used to assess cost-effectiveness, given the lack of definitive studies and t...
Source: Cochrane Database of Systematic Reviews - June 25, 2020 Category: General Medicine Authors: Natale P, Palmer SC, Ruospo M, Saglimbene VM, Strippoli GF Tags: Cochrane Database Syst Rev Source Type: research

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