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Hydralazine for pulmonary hypertension in low birth weight infants with chronic lung disease

In premature infants, pulmonary arterial hypertension (PAH) associated with chronic lung disease (CLD) is associated with high mortality rate. With the exception of oxygen supplementation, no specific interventions have been established as an effective treatment for PAH in premature infants with CLD. Vasodilators could be effective treatments to reduce pulmonary arterial pressure, but little has been proven regarding their clinical effectiveness and concern remains regarding adverse effects. This review found no trials of the use of hydralazine for low birth weight infant with PAH related to CLD. However, since hydralazine is inexpensive and potentially beneficial, randomised controlled trials are recommended.

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

Version: 2013

Hydralazine for treatment of high blood pressure

Hydralazine has been used for the treatment of high blood pressure since the 1950's. It is believed that hydralazine reduces blood pressure, however there are concerns due to the potential for this drug to cause adverse effects. The aim of this review was to determine the extent to which hydralazine reduces blood pressure, the nature of hydralazine’s adverse effect profile, and to determine the clinical impact of its use for hypertension. Unfortunately, the search revealed no randomized controlled trials which compared hydralazine to placebo as monotherapy for primary hypertension, therefore we are unable to make firm conclusions regarding its effects on blood pressure, adverse effects, or clinical outcomes. Some of the adverse effects related to hydralazine and that have been reported in the literature include reflex tachycardia, hemolytic anemia, vasculitis, glomerulonephritis, and a lupus‐like syndrome.

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

Version: 2012

Hydralazine for treatment of severe hypertension in pregnancy: meta-analysis

This review compared the effects of hydralazine with other antihypertensives for the treatment of severe hypertension in pregnancy. The authors concluded that the findings are not robust enough to guide clinical practice, though they do not support the use of hydralazine. The conclusions follow from the evidence presented, although there were some weaknesses in the conduct of the review.

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

Version: 2003

Favorable effects of vasodilators on left ventricular remodeling in asymptomatic patients with chronic moderate-severe aortic regurgitation and normal ejection fraction: a meta-analysis of clinical trials

BACKGROUND: The role of vasodilator therapy in asymptomatic patients with chronic moderate to severe aortic regurgitation (AR) and normal left ventricular (LV) function is uncertain. We assessed the effects of vasodilator therapy (hydralazine, calcium channel blockers, and angiotensin-converting enzyme inhibitors) in this subgroup of patient population.

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

Version: 2012

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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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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Drug Class Review: Direct Renin Inhibitors, Angiotensin Converting Enzyme Inhibitors, and Angiotensin II Receptor Blockers: Final Report [Internet]

The renin-angiotensin system is a complex biologic system between the heart, brain, blood vessels, and kidneys that leads to the production of biologically active agents, including angiotensin I and II and aldosterone, which act together to impact a variety of bodily functions including blood vessel tone, sodium balance, and glomerular filtration pressure. The multiple and varied effects of these agents allows the renin-angiotensin system to play a wide role in the pathology of hypertension, cardiovascular health, and renal function. Our ability to begin to intervene upon the complex cycle of hormone and other biochemical agent production within the renin-angiotensin system began with the advent of the first orally active ACE-I (angiotensin converting enzyme inhibitor), captopril, in 1981. AIIRAs (angiotensin II receptor blockers) were developed as an alternative to ACE-I, and block the interaction between angiotensin II and the angiotensin receptor. Losartan, the first commercially available AIIRA, was approved for clinical use in 1995. The goal of this report is to compare the effectiveness and harms between aliskiren and placebo and between AIIRAs and ACEIs in the treatment of diagnosed coronary heart disease, hypertension, left ventricular dysfunction, heart failure, nondiabetic chronic kidney disease, or diabetic nephropathy.

Drug Class Reviews - Oregon Health & Science University.

Version: January 2010
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Dementia: A NICE-SCIE Guideline on Supporting People With Dementia and Their Carers in Health and Social Care

This guideline has been developed to advise on supporting people with dementia and their carers in health and social care. The guideline recommendations have been developed by a multidisciplinary team of health and social care professionals, a person with dementia, carers and guideline methodologists after careful consideration of the best available evidence. It is intended that the guideline will be useful to practitioners and service commissioners in providing and planning high-quality care for those with dementia while also emphasising the importance of the experience of care for people with dementia and carers.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2007
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Racial and Ethnic Disparities in the VA Healthcare System: A Systematic Review [Internet]

Numerous studies have demonstrated racial and ethnic disparities in health care in the United States.These disparities have been demonstrated in the Veterans Affairs (VA) healthcare system, where financial barriers to receiving care are minimized. The VA is committed to delivering high-quality care in an equitable manner, and as such, to eliminating racial and ethnic disparities in health care. To inform this effort, we systematically reviewed the existing evidence on disparities within the VA, to address the following objectives: 1) Determine in which clinical areas racial and ethnic disparities are prevalent within the VA; 2) Describe what is known about the sources of those disparities; and 3) Qualitatively synthesize that knowledge to determine the most promising avenues for future research aimed at improving equity in VA health care.

Evidence-based Synthesis Program - Department of Veterans Affairs (US).

Version: June 2007
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Drugs for treatment of very high blood pressure during pregnancy

Pregnant women with very high blood pressure (hypertension) can reduce their blood pressure with antihypertensive drugs, but the most effective antihypertensive drug during pregnancy is unknown. The aim of antihypertensive therapy is to lower blood pressure quickly but safely for both the mother and her baby, avoiding sudden drops in blood pressure that can cause dizziness or fetal distress.

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

Version: 2013

Prevention and treatment of postpartum hypertension

Not enough evidence to know how best to treat women with hypertension after birth.

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

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

Oral beta‐blockers for mild to moderate hypertension during pregnancy

Pregnant women with mild to moderate hypertension taking beta‐blockers have reduced blood pressure, but these drugs may have adverse effects on the baby.

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

Version: 2012

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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Optimal strategies for identifying kidney disease in diabetes: properties of screening tests, progression of renal dysfunction and impact of treatment – systematic review and modelling of progression and cost-effectiveness

This study found evidence to support the use of annual screening to identify the development of early kidney disease in patients with diabetes, which is consistent with current UK guidelines. For type 1 diabetes, the costs of annual screening are well within the accepted level of cost-effectiveness, and, for patients with type 2 diabetes, annual screening is even more cost-effective.

Health Technology Assessment - NIHR Journals Library.

Version: February 2014
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Acute Heart Failure: Diagnosing and Managing Acute Heart Failure in Adults

The need for this guideline was identified as the NICE guidelines on chronic heart failure were being updated. We recognised at this time that there were important aspects of the diagnosis and management of acute heart failure that were not being addressed by the chronic heart failure guideline, which focussed on long term management rather than the immediate care of someone who is acutely unwell as a result of heart failure. The aim of this guideline is to provide guidance to the NHS on the diagnosis and management of acute heart failure.

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

Version: October 2014
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Clinical effectiveness and cost-effectiveness of second- and third-generation left ventricular assist devices as either bridge to transplant or alternative to transplant for adults eligible for heart transplantation: systematic review and cost-effectiveness model

This study found that while pulsatile ventricular assist devices used as bridge to heart transplant for advanced heart failure were clinically effective compared with medical management using inotropes, they failed to reach the standard level of cost-effectiveness set by the National Institute for Health and Care Excellence. It is clear that the technology is improving and currently in the base-case analysis over a lifetime horizon, cost-effectiveness approaches that for interventions adopted by the NHS as end of life treatments..

Health Technology Assessment - NIHR Journals Library.

Version: November 2013
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Multimorbidity: Assessment, Prioritisation and Management of Care for People with Commonly Occurring Multimorbidity

Multimorbidity is usually defined as when an individual has two or more long-term conditions. Measuring the prevalence of multimorbidity is not straightforward since this will vary depending on which conditions are counted, but all recent studies show that multimorbidity is common, becomes more common as people age, and is more common in people from less affluent areas. A recent large UK based study found that 42% of the population had at least one of the 40 conditions counted, and 23% had multimorbidity. Two-thirds of people aged 65 years or over had multimorbidity, and 47% had three or more conditions. People living in the most deprived areas had double the rate of multimorbidity in middle age than those living in the most affluent areas. Put another way, they developed multimorbidity 10-15 years before their more affluent peers. The recognition of multimorbidity associated with socioeconomic depreivation is particularly important as NHS England has a legal duty to have regard to the need to reduce health inequalities. Whereas rates of multimorbidity in older people was largely due to higher rates of physical conditions, in the less affluent multimorbidity was due to combinations of physical and mental health conditions was common.

NICE Guideline - National Guideline Centre (UK).

Version: September 2016
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Understanding the Intervention and Implementation Factors Associated with Benefits and Harms of Pay for Performance Programs in Healthcare [Internet]

Over the last decade, pay for performance (P4P) programs have been implemented in a variety of health systems, including the VHA, as a means to improve the efficiency and quality of health care. There has been a parallel increase in the number of studies examining the effects of P4P. A number of recent reviews have summarized this literature, but have generally found insufficient evidence to broadly characterize the balance of harms and benefits. However, financial incentives programs are complex interventions whose effects may depend in part on the settings in which they are implemented, the methods used for implementation, the populations targeted, and the characteristics of the incentive programs themselves.

Evidence-based Synthesis Program - Department of Veterans Affairs (US).

Version: May 2015
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Home telemonitoring or structured telephone support programmes after recent discharge in patients with heart failure: systematic review and economic evaluation

Study found that, despite wide variation in usual care and remote monitoring strategies for patients who have been recently discharged (within 28 days) from acute care after a recent exacerbation of heart failure, cost-effectiveness analyses suggested that telemonitoring during office hours is an optimal strategy in most costing scenarios but that further research is needed.

Health Technology Assessment - NIHR Journals Library.

Version: August 2013
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