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Cardiovascular outcomes in high-risk patients without heart failure treated with ARBs: a systematic review and meta-analysis

This review found no evidence that angiotensin II type I receptor antagonists (ARBs) confered cardiovascular protection akin to angiotensin-converting enzyme inhibitors. ARBs may have had a small benefit related to stroke risk, but this was difficult to quantify. The authors' conclusions reflected the evidence presented, but due to some methodological biases the reliability of the results are unclear.

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

Version: 2009

Preventive pharmacologic treatments for episodic migraine in adults

OBJECTIVES: Systematic review of preventive pharmacologic treatments for community-dwelling adults with episodic migraine.

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

Version: 2013

Angiotensin receptor blockers for the treatment of high blood pressure

A class of drugs called angiotensin receptor blockers (ARBs) is commonly used to lower high blood pressure. This class includes drugs such as losartan (brand name: Cozaar), candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), telmisartan (Micardis) and valsartan (Diovan). We asked how much this class of drugs lowers blood pressure and whether there is a difference between individual drugs within the class. The available scientific literature was searched to find all trials that had assessed these questions.

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

Version: 2009

Are angiotensin receptor blockers (ARBs) an effective treatment for heart failure?

Drugs called angiotensin receptor blockers (ARBs), such as losartan (brand name: Cozaar), candesartan (Atacand), eprosartan (Teveten), irbesartan (Avapro), telmisartan (Micardis) and valsartan (Diovan) are commonly used to treat heart failure. We asked whether ARBs reduced death, or severe disability as assessed by hospital admission for any reason versus an inert substance (placebo) or another class of drugs called ACE inhibitors, such as ramipril (Altace), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), and quinapril (Accupril). We also asked whether combining an ARB with an ACE inhibitor is more effective than an ACE inhibitor alone in reducing death, disability, or hospital admission for any reason. The scientific literature was searched to find all trials that had assessed these questions.

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

Version: 2012

Medications for high blood pressure in children

This systematic review includes 21 trials, involving 3454 children, which evaluated different medications to lower blood pressure among children with hypertension. This evidence is up to date as of October 2013. Most trials were of very short duration with the average being seven weeks. The studies were of variable quality and mostly industry funded. Not all studies compared the effect of medication on blood pressure lowering to a placebo. Only a few classes of the commonly prescribed drugs have been evaluated and most had a modest effect on blood pressure, but it is uncertain whether this results in improved long‐term outcomes for children. Higher doses of medication did not result in greater reduction of blood pressure. All of the drugs studied were safe for use, at least in the short term.

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

Version: 2014

Interventions To Improve Cardiovascular Risk Factors in People With Serious Mental Illness [Internet]

Individuals with serious mental illness (SMI) have excess mortality from cardiovascular disease (CVD) and high rates of CVD risk factors such as diabetes, obesity, and hyperlipidemia. We conducted a systematic review to evaluate interventions to improve CVD risk factors in adults with SMI.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: April 2013
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Migraine in Children: Preventive Pharmacologic Treatments [Internet]

To assess the comparative effectiveness and safety of preventive pharmacologic treatments for community-dwelling children with episodic or chronic migraine.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: June 2013
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Acute Kidney Injury: Prevention, Detection and Management Up to the Point of Renal Replacement Therapy [Internet]

Acute kidney injury (AKI), previously called acute renal failure, has chiefly been described as a syndrome since World War 2. Traditionally ‘acute renal failure’ was regarded as a less common organ failure, with patients typically requiring dialysis and managed by nephrologists. This view has now been overturned. AKI encompasses a wide spectrum of injury to the kidneys, not just ‘kidney failure’. It is a common problem amongst hospitalised patients, in particular the elderly population whose numbers are increasing as people live longer. Such patients are usually under the care of doctors practicing in specialties other than nephrology. For normal function the kidneys require a competent circulation. Conversely, it is known that renal function is vulnerable to even relative or quite modest hypotension or hypovolaemia. Hence AKI is a feature of many severe illnesses. Although these illnesses may affect many organs, the simple process of monitoring urine output and/or creatinine permits detection of AKI.

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

Version: August 2013
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Screening for Type 2 Diabetes Mellitus: Update of 2003 Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]

Diabetes poses a tremendous and increasing clinical and public health burden for Americans; 19.3 million Americans over the age of 20 years are affected, one third of whom are undiagnosed.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: June 2008
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Closing the Quality Gap: Revisiting the State of the Science (Vol. 4: Medication Adherence Interventions: Comparative Effectiveness)

To assess the effectiveness of patient, provider, and systems interventions (Key Question [KQ] 1) or policy interventions (KQ 2) in improving medication adherence for an array of chronic health conditions. For interventions that are effective in improving adherence, we then assessed their effectiveness in improving health, health care utilization, and adverse events.

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

Version: September 2012
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Diabetes in Pregnancy: Management of Diabetes and Its Complications from Preconception to the Postnatal Period

This clinical guideline contains recommendations for the management of diabetes and its complications in women who wish to conceive and those who are already pregnant. The guideline builds on existing clinical guidelines for routine care during the antenatal, intrapartum and postnatal periods. It focuses on areas where additional or different care should be offered to women with diabetes and their newborn babies.

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

Version: March 2008
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Hypertension: The Clinical Management of Primary Hypertension in Adults: Update of Clinical Guidelines 18 and 34 [Internet]

NICE first issued guidance for the management of hypertension in primary care in 2004. This was followed by a rapid update of the pharmacological treatment chapter of the guideline in 2006. The current partial update of the hypertension guideline is in response to the regular five year review cycle of existing NICE guidance. It began with a scoping exercise which identified key areas of the existing guideline for which new evidence had emerged that was likely to influence or change existing guideline recommendations.

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

Version: August 2011
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Migraine in Adults: Preventive Pharmacologic Treatments [Internet]

To assess comparative effectiveness and safety of preventive pharmacologic treatments for community-dwelling adults with episodic or chronic migraine.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: April 2013
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Stroke: National Clinical Guideline for Diagnosis and Initial Management of Acute Stroke and Transient Ischaemic Attack (TIA)

This guideline covers interventions in the acute stage of a stroke (‘acute stroke’) or transient ischaemic attack (TIA). Most of the evidence considered relates to interventions in the first 48 hours after onset of symptoms, although some interventions of up to 2 weeks are covered as well. This guideline is a stand-alone document, but is designed to be read alongside the Intercollegiate Stroke Working Party guideline ‘National clinical guideline for stroke’ which considers evidence for interventions from the acute stage into rehabilitation and life after stroke. The Intercollegiate Stroke Working Party guideline is an update of the 2004 2nd edition and includes all the recommendations contained within this guideline. This acute stroke and TIA guideline is also designed to be read alongside the Department of Health’s (DH) ‘National stroke strategy’ (NSS). Where there are differences between the recommendations made within this acute stroke and TIA guideline and the NSS, the Guideline Development Group (GDG) members feel that their recommendations are derived from systematic methodology to identify all of the relevant literature.

NICE Clinical Guidelines - National Collaborating Centre for Chronic Conditions (UK).

Version: 2008
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Screening for Hypertension in Children and Adolescents to Prevent Cardiovascular Disease: Systematic Review for the U.S. Preventive Services Task Force [Internet]

Hypertension in children can be associated with adverse health outcomes and may persist into adulthood, where it presents a significant personal and public health burden. Screening asymptomatic children has the potential to detect hypertension at earlier stages, so that interventions can be initiated which, if effective, could reduce the adverse health effects of childhood hypertension in children and adults.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: February 2013
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Chronic Kidney Disease Stages 1–3: Screening, Monitoring, and Treatment [Internet]

The objective was to systematically review and synthesize evidence regarding benefits and harms of screening for and monitoring and treatment of chronic kidney disease (CKD) stages 1–3.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: January 2012
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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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Dietary Supplements in Adults Taking Cardiovascular Drugs [Internet]

A substantial proportion of patients with cardiovascular diseases use dietary supplements in anticipation of benefit. This also poses risks of adverse events from supplement-drug interactions and nonadherence associated with polypharmacy.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: April 2012
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