September 12, 2012Volume 7 - Issue 37  

DynaMed Weekly Update

For the week ending September 7, 2012

Last week 462 articles were evaluated via DynaMed's Systematic Literature Surveillance and 211 were added to DynaMed content.   


Based on the editors' criteria of selecting "articles most likely to change clinical practice," one article of significant interest was selected for the DynaMed Weekly Update.

Feature Article

Antihypertensive Drug Therapy for Less Than 5 Years May Not Reduce Mortality or Cardiovascular Events in Adults with Mild Hypertension


A large proportion of patients diagnosed with hypertension have Stage 1 (mild) elevations in blood pressure, defined as systolic blood pressure 140-159 mm Hg or diastolic blood pressure 90-99 mm Hg. Many of these patients may have no other indications of cardiovascular disease, but antihypertensive medications are frequently prescribed for primary prevention, as recommended by the Seventh Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7) (Hypertension. 2003 Dec;42(6):1206). A recent Cochrane review compared antihypertensive drug therapy to placebo or no treatment in patients with mild hypertension.


Data from 8,912 patients from 4 randomized trials with treatment duration 2-5 years were analyzed. Subgroups of patients with mild hypertension were selected from 3 of the trials (7,900 patients, mean age 52 years). In a fourth trial, subgroup data were not available, but > 80% of the 1,012 participants had mild hypertension (mean age 38 years). First-line antihypertensive drugs included thiazide or thiazide-like diuretics, beta blockers or reserpine with additional therapies as needed.


Comparing any antihypertensive treatment to controls, there were no significant differences in mortality (risk ratio [RR] 0.85, 95% CI 0.63-1.15), incidence of coronary heart disease (RR 1.12, 95% CI 0.8-1.57), or total cardiovascular events (RR 0.97, 95% CI 0.72-1.32) (level 2 [mid-level] evidence). Antihypertensive treatment was associated with a trend toward reduced risk of stroke (0.3% with antihypertensives vs. 0.7% with control, p = 0.078) in an analysis of the largest trial (6,061 patients with mild hypertension). In an analysis of all 17,354 patients in that trial, including those with more severe hypertension, antihypertensive treatment was associated with increased withdrawals for adverse events (11.3% vs. 2.3%, p < 0.0001, NNH 11) (Cochrane Database Syst Rev 2012 Aug 15;(8):CD006742). This analysis is limited by the short duration of the included trials, which might limit the power to detect differences in mortality and other hard outcomes.


For more information, see the First-line therapy for hypertension topic in DynaMed.

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DynaMed Events  

Medicine 2.0 2012, September 15th - 16th, 2012    

Editor-in-Chief Dr. Brian Alper and Senior Deputy Editor Dr. Alan Ehrlich will be presenting at the 5th Annual World Congress on Social Media, Mobile Apps, and Internet/Web 2.0 in Medicine and Public Health, held at the Joseph B. Martin Conference Center at Harvard Medical School in Boston, MA. The topic of the presentation is "How Much Does Practice-Guiding Medical Knowledge Change in One Year?"


Visit the Medicine 2.0 '12 website to learn more about the event and for registration information.


Cochrane Colloquium, September 30th - October 3rd, 2012 
Editor-in-Chief Dr. Brian Alper will be presenting at the 20th Cochrane Collaboration Colloquium held at the Pullman Hotel in Auckland, New Zealand. The topic of the presentation is "Practice-driving evidence: how frequently does it change?"   


Visit the Cochrane Colloquium website to learn more about the event and for registration information.


First International Conference on Evidence Based HealthCare (ISEHCON), October 7th - 8th, 2012   

Editor-in-Chief Dr. Brian Alper will be leading a workshop at the First International Conference on Evidence Based Healthcare at the India International Centre in New Delhi, India. The topic of the workshop will be "Best Sources for Evidence-Based Literature for Healthcare Practitioners".   


Visit the International Society for Evidence Based Health Care website to learn more about the event and for registration information.

New topics added to DynaMed this week:

Medications for attention deficit hyperactivity disorder (ADHD) in children 

Call for Peer Reviewers

We are currently seeking reviewers for:

ACE inhibitors for heart failure 

Aldosterone antagonists for heart failure 

Diuretics for heart failure 


Learn more about the DynaMed Contribution Opportunities:

DynaMed Peer Review 

Editorial Policies for Reviewers 

About DynaMed Weekly Update

Prepared by the clinician members of the DynaMed Editorial Team, DynaMed Weekly Update is a compilation of one to five articles selected from DynaMed's Systematic Literature Surveillance as articles most likely to change clinical practice.

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CME Information


0.25 AMA PRA Category I Credit(s)™
Family Physicians: 0.25 Prescribed credits
Nurse Practitioners: 0.25 Contact hours
Release Date: September 12, 2012
Expiration Date: September 12, 2013
Estimated Completion Time:
15 minutes
There is no fee for this activity.

To Receive Credit 
In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.

Program Overview

Learning Objectives
Upon successful completion of this educational program, the reader should be able to:
1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.
Faculty Information
Alan Ehrlich, MD - Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Senior Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company

Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.


No commercial support has been received for this activity.

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ACCME: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote Education Company and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians. Antidote Education Company designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AAFP: Enduring Material activity, DynaMed Weekly Update, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 7, 2012. Term of approval is for one year from this date with the option of yearly renewal. Each Weekly Update is worth .25 Prescribed credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.


AANP: This program is approved for 0.25 contact hour of continuing education by the American Academy of Nurse Practitioners.


Program ID: 1102073B

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