Evidence-Based Medicine by ProQuest


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									           Evidence-Based Medicine
  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
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