This department uses the best available scientiﬁc ﬁndings to offer practice guidance on a wide range of
conditions seen in primary care.The author, Alan Ehrlich, MD, is a deputy editor for DynaMed, Ipswich,
Mass., and assistant clinical professor in Family Medicine, University of Massachusetts Medical School in
Worcester. DynaMed (www.ebscohost.com/dynamed/) is a database that provides evidence-based infor-
mation on more than 3,000 clinical topics and is updated daily through systematic surveillance covering
more than 500 journals.The most important evidence identiﬁed is summarized here.
INTENSIVE SYSTOLIC BP group (3.3% vs. 1.3%, P <0.001, NNH 50).
CONTROL MAY NOT REDUCE Adverse events reported (not all individually
MORTALITY IN PATIENTS signiﬁcant) included hypotension, syncope,
WITH DIABETES bradycardia or other arrhythmia, hyperkalemia,
Level 1: Likely reliable evidence angioedema, and renal failure (N Engl J Med.
Current guidelines from the American Diabetes 2010;362:1575-1585).
Association and other organizations recommend
a BP target <130/80 mm Hg for patients with LONG-TERM METFORMIN
diabetes (Diabetes Care. 2010;33 Suppl 1:S11- TREATMENT ASSOCIATED WITH
61). To date, there has been little experimental REDUCED VITAMIN B12 LEVELS
data to guide BP target recommendations, but Level 3: Lacking direct evidence
a new trial directly compared two different BP Metformin is a commonly prescribed ﬁrst-line
goals. The Action to Control Cardiovascular treatment for type 2 diabetes that not only low-
Risk in Diabetes BP trial (ACCORD BP) A systolic ers blood glucose concentrations but may also
compared intensive systolic BP control (target reduce cardiovascular mortality when used as
<120) vs. standard control (target <140) in BP target monotherapy or in combination with sulfonyl-
4,733 patients. While the trial did not stipulate below 120 did ureas. Metformin has previously been linked to
speciﬁc antihypertensive regimens, patients in not reduce reduced vitamin B12 levels, but a new random-
both groups were required to receive a drug ized trial with 390 patients is the ﬁrs