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Methyldopa reduces blood pressure in people with high blood pressure

Methyldopa is a medication that has been used to treat high blood pressure since the 1960s. While there is some belief methyldopa reduces blood pressure, 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 methyldopa reduces blood pressure, the nature of methyldopa's adverse effect profile, and to determine the clinical impact of its use for hypertension.The search revealed 12 trials with a total of 595 patients that were randomized to either a methyldopa treatment arm (296 patients) or a placebo treatment arm (299 patients). The daily doses of methyldopa used in these studies ranged 500‐2250 mg daily. The most commonly studied daily dose of methyldopa was 750 mg daily. Most studies followed patients for four to six weeks of therapy. None of the studies reported on the clinical impact of methyldopa (e.g. if methyldopa reduced the risk of having a stroke compared to placebo). Overall reporting of adverse effects was poor so no conclusions can be drawn about the adverse effect profile. This meta‐analysis shows that methyldopa reduces systolic/diastolic blood pressure by approximately 13/8 mmHg compared to placebo.

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

Version: 2009

Tight control of mild‐to‐moderate high blood pressure for pregnant women with pre‐existing or gestational hypertension (without protein in the urine) to improve health outcomes 

High blood pressure (hypertension) is defined as a systolic blood pressure of 140 mmHg or more or a diastolic blood pressure of 90 mmHg or more. In the general population, a tight control of blood pressure reduces cardiovascular risks and is particularly important for people with diabetes or renal disease. Having high blood pressure during pregnancy is a complex clinical condition. Adverse effects include premature separation of the placenta (abruption), low birthweight, and perinatal death. Women who do not have regular antenatal care, those with severe uncontrolled hypertension and pre‐eclampsia are more likely to have poor outcomes. A woman with mild‐to‐moderate hypertension could develop severe hypertension if not managed correctly. On the other hand, lowering blood pressure dramatically may reduce placental perfusion, which could lead to fetal growth restriction, without providing extra benefit to the mother. There is no consensus regarding a clear goal of adjusting blood pressure in pregnant women with mild‐to‐moderate hypertension.

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

Version: 2011

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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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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Drug Class Review: Second-Generation Antidepressants: Final Update 5 Report [Internet]

We compared the effectiveness and harms of second-generation antidepressants in the treatment of major depressive disorder (MDD), dysthymia, subsyndromal depression, seasonal affective disorder, generalized anxiety disorder, obsessive compulsive disorder, panic disorder, post-traumatic stress disorder, social anxiety disorder, and premenstrual dysphoric disorder.

Drug Class Reviews - Oregon Health & Science University.

Version: March 2011
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Antihypertensive drug therapy for mild to moderate hypertension during pregnancy

There is not enough evidence to show whether antihypertensive drug treatment for mild to moderate hypertension during pregnancy is worthwhile.

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

Version: 2014

Pentoxifylline for diabetic kidney disease

Kidney disease develops in 25% to 40% of diabetic patients, usually 20 to 25 years after the onset of diabetes. Approximately one third of those with diabetic kidney disease (DKD) will progress to end‐stage kidney disease (ESKD) and will require long‐term dialysis or possibly receive a kidney transplant. Many patients however may die from associated coronary artery disease or other cardiovascular causes before the onset of ESKD. Pentoxifylline has been described as offering properties that may be beneficial for patients with DKD. We reviewed 17 randomised controlled studies, enrolling 991 patients with DKD, which compared pentoxifylline with placebo, routine treatment or antihypertensive drugs.

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

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

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

Clinical guidelines have been defined as ‘systematically developed statements which assist clinicians and patients in making decisions about appropriate treatment for specific conditions’. This clinical guideline concerns the management of diabetes and its complications from preconception to the postnatal period. It has been developed with the aim of providing guidance on:

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

Version: February 2015
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Enabling Medication Management Through Health Information Technology

The objective of the report was to review the evidence on the impact of health information technology (IT) on all phases of the medication management process (prescribing and ordering, order communication, dispensing, administration and monitoring as well as education and reconciliation), to identify the gaps in the literature and to make recommendations for future research.

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

Version: April 2011
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Menopausal Symptoms: Comparative Effectiveness of Therapies [Internet]

To systematically review and synthesize evidence evaluating the comparative effectiveness of treatments for menopausal symptoms, along with potential long-term benefits and harms of those treatments.

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

Version: March 2015
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Menopause: Full Guideline

In summary, a large number of women in the UK experience menopausal symptoms which, in many cases, can significantly affect their quality of life. It is probable that a minority of these women seek medical treatment and for those who do there is considerable variation in the help available, with many being told that the symptoms will get better with time. Since symptoms may often continue for 7 years or more, this advice is inappropriate and help should be offered where possible. Women need to know about the available options and their risks and benefits, and be empowered to become part of the decision-making process.

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

Version: November 12, 2015
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Eating Disorders: Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorders

This guideline has been developed to advise on the identification, treatment and management of the eating disorders anorexia nervosa, bulimia nervosa and related conditions. The guideline recommendations have been developed by a multidisciplinary group of health care professionals, patients and their representatives, and guideline methodologists after careful consideration of the best available evidence. It is intended that the guideline will be useful to clinicians and service commissioners in providing and planning high quality care for those with eating disorders while also emphasising the importance of the experience of care for patients and carers.

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

Version: 2004
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Non-Invasive Diagnostic Assessment Tools for the Detection of Liver Fibrosis in Patients with Suspected Alcohol-Related Liver Disease: A Systematic Review and Economic Evaluation

Excessive alcohol consumption may lead to the development of alcoholrelated liver disease (ALD). Liver biopsy may be used in patients with suspected ALD to confirm the diagnosis, exclude other or additional liver pathologies, and provide accurate staging of the degree of liver injury in order to enable the prediction of prognosis and inform treatment decisions. However, as it is an invasive procedure that carries the risk of morbidity and mortality, current UK guidance recommends that biopsy is not required to confirm the diagnosis in patients with a high clinical suspicion of ALD in whom blood tests have excluded other causes of liver disease, unless it is necessary to confirm a diagnosis of acute alcoholic hepatitis in order to inform specific treatment decisions.

Health Technology Assessment - NIHR Journals Library.

Version: February 2012
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Depression in Adults with a Chronic Physical Health Problem: Treatment and Management

This clinical guideline was commissioned by NICE and developed by the National Collaborating Centre for Mental Health. It sets out clear, evidenceand consensus-based recommendations for healthcare staff on how to treat and manage depression in adults with a chronic physical health problem.

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

Version: 2010
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Drug Class Review: Atypical Antipsychotic Drugs: Final Update 3 Report [Internet]

Atypical antipsychotic agents are used to treat the symptoms of schizophrenia and bipolar disorder. The purpose of this review is to help policy makers and clinicians make informed choices about their use. Given the prominent role of drug therapy in psychiatric disease, our goal is to summarize comparative data on efficacy, effectiveness, tolerability, and safety. Ten atypical antipsychotics are currently available in the United States and Canada. Clozapine, the prototypic atypical antipsychotic, was introduced in 1989. Since then, 9 other atypical antipsychotics have been brought to market: risperidone (1993), risperidone long-acting injection (2003), olanzapine (1996), quetiapine (1997), ziprasidone (2001), aripiprazole (2002), extended-release paliperidone (2006), asenapine (2009), iloperidone (2009), and paliperidone long-acting injection (2009).

Drug Class Reviews - Oregon Health & Science University.

Version: July 2010
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Parkinson's Disease: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care

It is almost 200 years since James Parkinson described the major symptoms of the disease that came to bear his name. Slowly but surely our understanding of the disease has improved and effective treatment has been developed, but Parkinson’s disease remains a huge challenge to those who suffer from it and to those involved in its management. In addition to the difficulties common to other disabling neurological conditions, the management of Parkinson’s disease must take into account the fact that the mainstay of pharmacological treatment, levodopa, can eventually produce dyskinesia and motor fluctuation. Furthermore, there are a number of agents besides levodopa that can help parkinsonian symptoms, and there is the enticing but unconfirmed prospect that other treatments might protect against worsening neurological disability. Thus, a considerable degree of judgement is required in tailoring individual therapy and in timing treatment initiation. It is hoped that this guideline on Parkinson’s disease will be of considerable help to those involved at all levels in these difficult management decisions. The guideline has been produced using standard NICE methodology and is therefore based on a thorough search for best evidence.

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

Version: 2006
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Oral antihypertensive therapy for severe hypertension in pregnancy and postpartum: a systematic review

BACKGROUND: Pregnant and postpartum women with severe hypertension are at increased risk of stroke and require blood pressure (BP) reduction. Parenteral antihypertensives have been most commonly studied, but oral agents would be ideal for use in busy and resource-constrained settings.

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

Version: 2014

Do commonly used oral antihypertensives alter fetal or neonatal heart rate characteristics: a systematic review

OBJECTIVE: To examine fetal (FHR) and neonatal heart rate patterns following use of common oral antihypertensives in pregnancy.

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

Version: 2004

Systematic Reviews in PubMed

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