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Treats and prevents angina. This medicine is a nitrate.

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Meta-analysis of randomized controlled trials on the efficacy of Di'ao Xinxuekang capsule and isosorbide dinitrate in treating angina pectoris

Objective. Randomized controlled trials (RCTs) on di'ao xinxuekang capsule (XXK) in treating angina pectoris were published only in Chinese and have not been systematically reviewed particularly for comparing XXK with isosorbide dinitrate (ISDN). This study aims to provide a comprehensive PRISMA compliant and internationally accessible systematic review and meta-analysis to evaluate the efficacies of XXK and ISDN in treating angina pectoris. Methods. The RCTs published between 1989 and 2011 on XXK and ISDN in treating angina pectoris were selected according to specific criteria. Meta-analysis was performed to evaluate the symptomatic (SYMPTOMS) and electrocardiographic (ECG) improvements after treatment. Odds ratios (OR) were used to measure effect sizes. Subgroup analysis, sensitivity analysis, and metaregression were conducted to evaluate the robustness of the results. Results. Seven RCTs with 550 participants were eligible. Overall ORs for comparing XXK with ISDN were 4.11 (95% CI :  2.57, 6.55) in SYMPTOMS and 2.37 (95% CI : 1.46, 3.84) in ECG. Subgroup analysis, sensitivity analysis, and metaregression found no significant dependence of overall ORs upon specific study characteristics. Conclusion. The meta-analysis of eligible but limited RCTs demonstrates that XXK seems to be more effective than ISDN in treating angina pectoris. Further RCTs of high quality are warranted to be conducted for update of the results of this meta-analysis.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Is danshen (Salvia miltiorrhiza) dripping pill more effective than isosorbide dinitrate in treating angina pectoris? A systematic review of randomized controlled trials

BACKGROUND: Danshen dripping pill (DSP) is a popular Chinese medicinal product and often compared with isosorbide dinitrate (ISDN) in treating coronary heart disease angina pectoris. Over 100 randomized controlled trials (RCT) have been published in Chinese language but have not been evaluated according to the PRISMA systematic review standard. This study aims to provide a comprehensive and PRISMA-compliant systematic review with sensitivity and subgroup analyses.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Is tongxinluo more effective than isosorbide dinitrate in treating angina pectoris? A systematic review and meta-analysis of randomized controlled trials

BACKGROUND: Tongxinluo (TXL), consisting of 12 Chinese Materia Medica items catalogued in the Chinese Pharmacopoeia, is commercially available in China, South Korea, and Russia. Hundreds of randomized clinical trials (RCTs) on TXL in treating cardiovascular diseases were conducted and published in China. This study provides a comprehensive Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant systematic review with sensitivity and subgroup analyses to evaluate the evidence about whether TXL is more effective than isosorbide dinitrate (ISDN) in treating ischemic heart disease, particularly angina pectoris.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Beta-blockers plus isosorbide-5-mononitrate for prevention of esophageal variceal rebleeding: a systematic review

Bibliographic details: Sun XB, Wang Q, Shi W, Nong CY, Li Y, Chao QC, Zhao C.  Beta-blockers plus isosorbide-5-mononitrate for prevention of esophageal variceal rebleeding: a systematic review. Chinese Journal of Hepatology 2008; 16(8): 632-63318752758

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

Efficacy of beta-adrenergic blocker plus 5-isosorbide mononitrate and endoscopic band ligation for prophylaxis of esophageal variceal rebleeding: a meta-analysis

The authors concluded that beta-adrenergic blocker plus 5-isosorbide mononitrate was as effective as endoscopic band ligation for the prophylaxis of oesophageal variceal re-bleeding. Evidence appeared to support the authors’ conclusions, but limitations in review methods and analyses based on findings of no significant difference from a few trials weaken the strength of this evidence.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Meta-analysis: isosorbide-mononitrate alone or with either beta-blockers or endoscopic therapy for the management of oesophageal varices

This review reported that isosorbide mononitrate alone or in combination with beta blockers did not appear to reduce bleeding in primary or secondary prevention of oesophageal varices. Survival may have increased in comparison with endoscopic therapy. Further research was required. These cautious conclusions and recommendations for research appear appropriate given the limitations of the evidence.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Systematic review: secondary prevention with band ligation, pharmacotherapy or combination therapy after bleeding from oesophageal varices

BACKGROUND: Variable methods are available for secondary prevention after oesophageal variceal bleeding (EVB).

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

Endoscopic band ligation versus pharmacological therapy for variceal bleeding in cirrhosis: a meta-analysis

OBJECTIVE: To conduct a meta-analysis of published, full-length, randomized controlled trials evaluating the efficacy of endoscopic band ligation (EBL) versus pharmacological therapy for the primary and secondary prophylaxis of variceal hemorrhage in patients with cirrhosis.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Chronic Heart Failure: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care: Partial Update [Internet]

This guideline is a partial update of NICE Guideline No 5: Chronic Heart Failure - national clinical guideline for diagnosis and management in primary and secondary care (2003). The aim of the 2003 guideline was to offer best practice advice on the care of adult patients (aged 18 years or older) who have symptoms or a diagnosis of chronic heart failure. It defined the most effective combination of symptoms, signs and investigations required to establish a diagnosis of heart failure, and those which would influence therapy or provide important prognostic information. It also gave guidance on the treatment, monitoring and support of patients with heart failure.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: August 2010
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Enabling Patient-Centered Care Through Health Information Technology

The main objective of the report is to review the evidence on the impact of health information technology (IT) that supports patient-centered care (PCC) on: health care processes; clinical outcomes; intermediate outcomes (patient or provider satisfaction, health knowledge and behavior, and cost); responsiveness to needs and preferences of patients; shared decisionmaking and patient–clinician communication; and access to information. Additional objectives were to identify barriers and facilitators for using health IT to deliver PCC, and to identify gaps in evidence and information needed by patients, providers, payers, and policymakers.

Evidence Reports/Technology Assessments - Agency for Healthcare Research and Quality (US).

Version: June 2012
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Hypertension in Pregnancy: The Management of Hypertensive Disorders During Pregnancy

This clinical guideline concerns the management of hypertensive disorders in pregnancy and their complications from preconception to the postnatal period. For the purpose of this guideline, ‘pregnancy’ includes the antenatal, intrapartum and postpartum (6 weeks after birth) periods. The guideline has been developed with the aim of providing guidance in the following areas: information and advice for women who have chronic hypertension and are pregnant or planning to become pregnant; information and advice for women who are pregnant and at increased risk of developing hypertensive disorders of pregnancy; management of pregnancy with chronic hypertension; management of pregnancy in women with gestational hypertension; management of pregnancy for women with pre-eclampsia before admission to critical care level 2 setting; management of pre-eclampsia and its complications in a critical care setting; information, advice and support for women and healthcare professionals after discharge to primary care following a pregnancy complicated by hypertension; care of the fetus during pregnancy complicated by a hypertensive disorder.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: August 2010
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Stable Angina: Methods, Evidence & Guidance [Internet]

Angina is pain or constricting discomfort that typically occurs in the front of the chest (but may radiate to the neck, shoulders, jaw or arms) and is brought on by physical exertion or emotional stress. It is the main symptomatic manifestation of myocardial ischaemia and is usually caused by obstructive coronary artery disease restricting oxygen delivery to the cardiac myocytes. Other factors may exacerbate angina either by further restricting oxygen delivery (for example severe anaemia) or by increasing oxygen demand (for example left ventricular hypertrophy). Angina symptoms are associated with other cardiac disease such as aortic stenosis but the management of angina associated with non-coronary artery disease is outside the scope of this guideline.

NICE Clinical Guidelines - National Clinical Guidelines Centre (UK).

Version: July 2011
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Oral panax notoginseng preparation for coronary heart disease: a systematic review of randomized controlled trials

This systematic review aims to evaluate current evidence for the benefit and side effect of oral Panax notoginseng preparation for coronary heart disease (CHD). We included 17 randomized clinical trials (17 papers and 1747 participants). Comparing with no intervention on the basis of conventional therapy, oral Panax notoginseng did not show significant effect on reducing cardiovascular events, but it could alleviate angina pectoris (including improving the symptoms of angina pectoris [RR 1.20; 95% CI 1.12 to 1.28; 7 trials, n = 791], improving electrocardiogram [RR 1.35; 95% CI 1.19 to 1.53; 8 trials, n = 727], decreasing the recurrence of angina pectoris [RR 0.38; 95% CI 0.16 to 0.94; 1 trials, n = 60], duration of angina pectoris [RR -1.88; 95% CI -2.08 to -1.69; 2 trials, n = 292], and dosage of nitroglycerin [MD -1.13; 95% CI -1.70 to -0.56; 2 trials, n = 212]); oral Panax notoginseng had no significant difference compared with isosorbide dinitrate on immediate effect for angina pectoris [RR 0.96; 95% CI 0.81 to 1.15; 1 trial, n = 80]. In conclusion, oral Panax notoginseng preparation could relieve angina pectoris related symptoms. However, the small sample size and potential bias of most trials influence the convincingness of this conclusion. More rigorous trials with high quality are needed to give high level of evidence, especially for the potential benefit of cardiovascular events.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Oral panax notoginseng preparation for coronary heart disease: a systematic review of randomized controlled trials

This systematic review aims to evaluate current evidence for the benefit and side effect of oral Panax notoginseng preparation for coronary heart disease (CHD). We included 17 randomized clinical trials (17 papers and 1747 participants). Comparing with no intervention on the basis of conventional therapy, oral Panax notoginseng did not show significant effect on reducing cardiovascular events, but it could alleviate angina pectoris (including improving the symptoms of angina pectoris [RR 1.20; 95% CI 1.12 to 1.28; 7 trials, n = 791], improving electrocardiogram [RR 1.35; 95% CI 1.19 to 1.53; 8 trials, n = 727], decreasing the recurrence of angina pectoris [RR 0.38; 95% CI 0.16 to 0.94; 1 trials, n = 60], duration of angina pectoris [RR -1.88; 95% CI -2.08 to -1.69; 2 trials, n = 292], and dosage of nitroglycerin [MD -1.13; 95% CI -1.70 to -0.56; 2 trials, n = 212]); oral Panax notoginseng had no significant difference compared with isosorbide dinitrate on immediate effect for angina pectoris [RR 0.96; 95% CI 0.81 to 1.15; 1 trial, n = 80]. In conclusion, oral Panax notoginseng preparation could relieve angina pectoris related symptoms. However, the small sample size and potential bias of most trials influence the convincingness of this conclusion. More rigorous trials with high quality are needed to give high level of evidence, especially for the potential benefit of cardiovascular events.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Nitrates for acute heart failure syndromes

Heart failure occurs when the lower muscular heart chamber is unable to fill or eject blood normally due to heart disease of any origin. Acute heart failure syndromes (AHFS) are defined as gradual or rapid (over a period of less than 48 hours) deterioration in heart failure signs and symptoms resulting in a need for urgent therapy. There are many types of drugs and non‐drug based interventions used for the treatment of AHFS. The aim of this review has been to determine the effectiveness and safety of nitrates (one drug group used for the treatment of AHFS) compared with alternative interventions in the treatment of patients with AHFS.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Nitrates (medicines) for achalasia (impaired swallowing)

Achalasia is a condition where the lower part of the oesophagus leading to the stomach is unable to relax normally after swallowing. Food may become stuck there rather than going through into the stomach. Although the cause of achalasia is not known, it is well demonstrated that loss of oesophageal neurons is the underlying problem. Patients may experience dysphagia, regurgitation of food, retrosternal pain and so on. Nitrates are drugs that may relax the muscle and they are used to try to relieve the symptoms. They can be taken either as tablets, or absorbed under the tongue. Nitrates can be used in patients with mild symptoms, where it is not necessary to perform an invasive procedure such as surgery or if the patient is not a suitable candidate for surgery for some other reason. Nitrates can also be used if there is no response to injections of botulinum toxin to relax the muscle of the oesophagus. One other widely used option for the treatment of achalasia is dilation of the oesophagus using endoscopic methods. This review found there is not enough evidence from trials to show if nitrates are an effective treatment to relieve achalasia.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Chinese herbal medicine suxiao jiuxin wan for angina pectoris

Angina pectoris is pain or discomfort within the chest, typically provoked by exertion or anxiety. Angina is a sign that someone is at increased risk of heart attack, cardiac arrest or sudden cardiac death. The aim of treatment for angina is to control the symptoms and prevent a cardiovascular event such as a heart attack. In western medicine, treatment is usually with beta blockers, calcium channel blockers and nitrates (nitroglycerin). Suxiao jiuxin wan is widely used in China in conjunction with these western treatments. This review found weak evidence to suggest suxiao jiuxin wan alone or in combination with other anti‐anginal drugs reduces the symptoms of angina. However, because of the quality of the research, the role of suxiao jiuxin wan is uncertain and more high quality trials are required to assess the effects of suxiao jiuxin wan in the long term.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Systematic guideline search and appraisal, as well as extraction of new and relevant recommendations, for the DMP “diabetes mellitus type 2”: Executive summary of final report: V09-04, Version 1.0

The aim of this study was to specify a potential need for updating and supplementation of the existing DMP “diabetes mellitus type 2” by systematically searching for new, topic-relevant, evidence-based guidelines and by synthesizing the guideline recommendations.

Institute for Quality and Efficiency in Health Care: Executive Summaries [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: November 7, 2011

Diagnosis and Treatment of Erectile Dysfunction

To systematically review the evidence on efficacy and harms of pharmaceutical treatments used in the management of male erectile dysfunction (ED); to explore the clinical utility of routine hormonal blood tests (e.g. testosterone, prolactin) for identifying and treating hormonal disorders and thereby affecting therapeutic outcomes for ED.

Evidence Reports/Technology Assessments - Agency for Healthcare Research and Quality (US).

Version: May 2009
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Compound Salvia droplet pill, a traditional Chinese medicine, for the treatment of unstable angina pectoris: a systematic review

The authors reported that compound Salvia droplet pill has a significant effect on improving angina symptoms, electrocardiography and level of blood lipids in patients with unstable angina pectoris, with few side-effects. However, they concluded that the evidence is unreliable because of the low quality of the included trials. This was a well-conducted review and the conclusions are likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2008

Systematic Reviews in PubMed

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