Evidence
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Spironolactone is effective for treating resistant hypertension

This trial investigated which drug is best added to high blood pressure (hypertension) treatment if blood pressure has not come down to normal levels after taking three blood pressure lowering drugs. Such “resistant hypertension” accounts for around 10% of all people who have hypertension. The study found that adding spironolactone to the existing three-drug regimen was ...

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A new, simple postural manoeuvre can stop an abnormally fast heart rate

A simple postural change to the Valsalva manoeuvre (see Definitions) improves the effectiveness of this cheap, non-invasive means of treating supraventricular tachycardia - an abnormally fast heart rate over 100 beats per minute. The NIHR funded a pragmatic trial of the promising technique in ten hospital emergency departments in England. The trial found that laying ...

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Clinics and activities in primary care can reduce heart disease deaths

This review found that primary care interventions at an organisational level for people with coronary heart disease reduced death rates for up to six years after the intervention, compared to usual care. The structured interventions lasted between one and three years and included activities like organising dedicated clinics to monitor and adjust medication to meet ...

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Drug therapy after a coronary stent should be tailored to patient’s risk profile

This systematic review tried to find the optimal duration of dual antiplatelet therapy, usually aspirin and clopidogrel, after coronary stenting. Compared to standard antiplatelet therapy for 12 months, shorter treatment had little impact on stent thrombosis. Treatment for longer than 12 months did, however, reduce thrombosis by 67% (about 7 events per 1000 people).  Major ...

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Resveratrol supplements do not improve cardiovascular risk markers

This systematic review of trials found that resveratrol supplements do not improve the results of tests that indicate risk of heart disease, including levels of blood pressure, blood glucose, cholesterol or C-reactive protein. Resveratrol is found naturally in red grapes, other fruits, and nuts. Some researchers think resveratrol in red wine may lower the risk ...

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Self-monitoring of warfarin is safe and cost-effective

This NIHR-funded systematic review investigated the clinical and cost-effectiveness of self-monitoring by people receiving long-term anticoagulation using vitamin K antagonists, most commonly, warfarin. People receiving warfarin require regular blood tests to see how their blood is clotting and to adjust their dose to avoid bleeding from too high a dose or thrombosis (clots) if the ...

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Laser treatment is the preferred treatment for troublesome varicose veins

Initial results from this trial (CLASS) found that the three main treatments for varicose veins all improved symptoms and quality of life six months after treatment. On a balance of scores, laser treatment was more effective than foam treatment or surgery. Laser involved fewest complications six weeks after the procedure and may be the most ...

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Interventions that help and harm patients in the critical care unit

This systematic review and expert consensus process found 15 non-surgical interventions affecting adult mortality in critical care. Seven interventions, such as the use of tranexamic acid after severe blood loss, reduced deaths. Eight interventions, such as improving oxygen supply by using a drug, dobutamine, increased them. 2015 UK guidelines only partly reflect these findings. They ...

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Restricting blood transfusion may not be effective after cardiac surgery

This large NIHR-funded randomised trial found that using a lower haemoglobin threshold was no better or cheaper than using a higher one when deciding to transfuse blood after non-emergency cardiac surgery. People with milder anaemia, receiving blood transfusion at a haemoglobin level less than 90g/L (the liberal transfusion group) had similar health outcomes and health ...

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