Top 20 Research Studies of 2017 for Primary Care Physicians

Mark H. Ebell, MD, MS; Roland Grad, MD, MSc,

Disclosures

Am Fam Physician. 2018;97(9):581-588. 

In This Article

Cardiovascular Disease and Hypertension

The first group of POEMs focuses on cardiovascular disease (CVD) and hypertension (Table 1),[10–14] and two of these POEMs address the proper way to measure blood pressure, a part of the care of almost every patient. Although it may be tempting to save a few seconds and measure the blood pressure through a patient's shirt or sweater, Study 1, a Japanese study, found that measuring through clothing can add 6 to 7 mm Hg to the diastolic blood pressure and 4 mm Hg to the systolic blood pressure.[10] In Study 2, Dutch patients with suspected white coat hypertension were asked to sit quietly in a room while an automated cuff measured their blood pressure every five minutes. The mean of these six measurements was 23/12 mm Hg lower than the initial office blood pressure.[11] Study 3 is a reanalysis of data from the Systolic Blood Pressure Intervention Trial (SPRINT). It concluded that for patients with hypertension but without diabetes mellitus who are at increased risk of CVD (average age = 68 years; 61% with a 10-year cardiovascular risk of 15% or greater), a more aggressive blood pressure target has cardiovascular benefits and renal harms, and requires more medications.[12] As with the Dutch study, the SPRINT trial used a similar measurement approach (i.e., the mean of three automated blood pressure measurements after the patient had rested quietly for at least five minutes), so before increasing the number of blood pressure medications that patients use to hit those targets, it is critical to measure blood pressure the same way as the SPRINT investigators. Another study of blood pressure measurement, Study 4, concluded that when evaluating a patient for possible orthostatic hypotension, it is better to measure the blood pressure one minute after standing rather than three minutes.[13]

Statins are commonly prescribed to patients 65 years and older, but are they effective for primary prevention of CVD? Study 5 randomized nearly 3,000 adults 65 years and older without known CVD to receive pravastatin (Pravachol; 40 mg per day) or placebo. No reduction in coronary events or all-cause mortality was found, and a nonsignificant trend toward higher mortality in patients older than 75 years was observed in those taking the statin (hazard ratio = 1.34; 95% confidence interval, 0.98 to 1.84).[14]

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