{"id":38113,"date":"2013-08-27T11:42:52","date_gmt":"2013-08-27T15:42:52","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=voices&#038;p=38113"},"modified":"2013-08-27T11:42:52","modified_gmt":"2013-08-27T15:42:52","slug":"selections-from-richard-lehmans-literature-review-august-27th","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2013\/08\/27\/selections-from-richard-lehmans-literature-review-august-27th\/","title":{"rendered":"Selections from Richard Lehman\u2019s Literature Review: August 27th"},"content":{"rendered":"<p><em>CardioExchange is pleased to reprint this selection from Dr. Richard Lehman\u2019s\u00a0<a href=\"http:\/\/blogs.bmj.com\/bmj\/category\/richard-lehmans-weekly-review-of-medical-journals\/\" target=\"_blank\">weekly journal review blog<\/a>\u00a0at\u00a0<a href=\"http:\/\/www.bmj.com\/\">BMJ.com<\/a>. Selected summaries are relevant to our audience, but we encourage members to engage with the\u00a0<a title=\"Lehman_8282012\" href=\"http:\/\/blogs.bmj.com\/bmj\/2013\/08\/27\/richard-lehmans-journal-review-27-august-2013\/\" target=\"_blank\">entire blog<\/a>.<\/em><\/p>\n<p><strong>Ann Intern Med\u00a0 20 Aug 2013\u00a0 Vol 159<\/strong><\/p>\n<p><strong>BP and Mortality in U.S. Veterans with CKD (pg. 233):<\/strong> Following Ray Moynihan et al\u2019s measured argument in the <em>BMJ<\/em> against labelling 11% of adults as having \u201cchronic kidney disease,\u201d there have been lots of responses from single interest people to the effect that this is so that we can target them for special preventive treatment, including tighter control of blood pressure. <a href=\"http:\/\/annals.org\/article.aspx?articleid=1726794\">This study of US Veterans with CKD<\/a> introduces some observational evidence into the debate. Lowering diastolic BP in these people below 70 is associated with higher mortality, irrespective of the systolic pressure. The best outcomes were seen with diastolics between 70 and 89, and systolics between 130 and 159 Hg. Note that last figure. Male \u201cpatients with CKD\u201d\u2014mostly healthy asymptomatic people\u2014are quite OK to run a systolic BP up to 159, and not OK to run a diastolic below 70. These figures bear no relation to any targets set by tunnel-vision committees of specialists and CKD \u201cchampions,\u201d and apply equally to those with albuminuria and those without.<\/p>\n<p><strong>JAMA\u00a0 21 Aug 2013\u00a0 Vol 310<\/strong><\/p>\n<p><strong>Improved BP Control Associated with a Large-Scale Hypertension Program (pg. 699):<\/strong> <a href=\"http:\/\/jama.jamanetwork.com\/article.aspx?articleid=1730511\">A structured hypertension management programme by Kaiser Permanente in the USA achieves better BP control than usual care<\/a>. Strange indeed had it been otherwise. There\u2019s not much for NHS doctors to learn from here: keep collecting the QOF BP points.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>This week&#8217;s topics include BP and mortality in U.S. veterans with CKD and improved BP control associated with a large-scale hypertension program.<\/p>\n","protected":false},"author":475,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[456,453,454],"class_list":["post-38113","post","type-post","status-publish","format-standard","hentry","category-general","tag-blood-pressure","tag-chronic-kidney-disease","tag-hypertension"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/38113","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/475"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=38113"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/38113\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=38113"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=38113"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=38113"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}