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[null,null,null,"Include"]
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[null,"Canllaw penodol ar bwysedd gwaed uchel"]
[null,"Ffynhonnell:","Cynulleidfa:","Argymhellion:"]
[null,"National Institute for Heath and Care Excellence. Hypertension in adults: diagnosis and management. NG136. London: NICE, 2019\nAvailable here.\n\n\nUnderpinning evidence reviews available here.","This guideline is for healthcare professionals; commissioners, and providers; people who have or may have high blood pressure, their families and carers.\n","This guideline covers identifying and treating primary hypertension (high blood pressure) in people aged 18 and over, including people with type 2 diabetes. It aims to reduce the risk of cardiovascular problems such as heart attacks and strokes by helping healthcare professionals to diagnose hypertension accurately and treat it effectively.\n\nRecommendations\n\nThis guideline includes new and updated recommendations on:\n•diagnosing hypertension\n•starting antihypertensive drug treatment\n•monitoring treatment and blood pressure targets\n•choosing antihypertensive drug treatment (treatment steps 1 to 4)\n•who to refer for same-day specialist review\n\nIt also includes unchanged recommendations on:\n\n•measuring blood pressure\n•assessing cardiovascular risk and target organ damage\n•lifestyle interventions\n"]
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[null,"National Institute for Health and Care Excellence. Hypertension in adults. QS28. London: NICE, 2013. \nAvailable here.\n\nLast updated September 2015. ","This quality standard should be used by commissioners and providers of health and social care when designing high-quality services and could also be used by patients, service users and carers to find out about the quality of care they should expect to receive; support asking questions about the care they receive; and to make a choice between providers of social care services. ","This quality standard covers managing hypertension in adults. It includes diagnosis and investigations, treatment and specialist referral. It describes high-quality care in priority areas for improvement.\n\nThe quality standard for hypertension states that services should be commissioned from and coordinated across all relevant agencies encompassing the hypertension care pathway. A person-centred approach to provision of services is fundamental in delivering high-quality care to adults with hypertension.\n\nThe quality statements are as follows:\n\n -  Statement 1: People with suspected hypertension are offered ambulatory blood pressure monitoring (ABPM) to confirm a\n     diagnosis of hypertension.\n\n -  Statement 2: People with newly diagnosed hypertension receive investigations for target organ damage within 1 month\n     of diagnosis. \n\n -  Statement 3: This statement has been replaced by quality statements on primary and secondary prevention of\n     cardiovascular disease in cardiovascular disease risk assessment and lipid modification (NICE quality standard 100).\n\n -  Statement 4: People with treated hypertension have a clinic blood pressure target set to below 140/90 mm Hg if aged\n     under 80 years, or below 150/90 mm Hg if aged 80 years and over.  \n\n -  Statement 5: People with hypertension are offered a review of risk factors for cardiovascular disease annually.\n\n -  Statement 6: People with resistant hypertension who are receiving four antihypertensive drugs and whose blood\n     pressure remains uncontrolled are referred for specialist assessment. \n\nOther quality standards that should also be considered when choosing, commissioning or providing a high-quality hypertension service are listed in related NICE quality standards.\n\n"]
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[null,"BMJ Best Practice. (2020). Essential Hypertension. London: BMJ Publishing Group Ltd. \nAvailable here.\n\nLast updated November 2020.","Medical professionals situated outside of the United States and Canada. ","The BMJ Best Practice summary on essential hypertension includes information on the definition, epidemiology, aetiology and pathophysiology of hypertension, along with information on prevention, diagnosis, treatment and follow-up and details of current diagnostic and treatment guidelines.\n\nIt states that hypertension is typically diagnosed by screening of an asymptomatic individual. Treatment of uncontrolled hypertension reduces the risks of mortality and of cardiac, vascular, renal and cerebrovascular complications. Lifestyle changes are recommended for all patients: weight loss, exercise, decreased sodium intake, dietary approaches to stop hypertension (DASH) and moderation of alcohol consumption. Choice of drug therapy is often driven by considerations related to comorbid disease, but achievement of blood pressure goal may be accomplished with a variety of therapeutic agents. "]
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[null,"BMJ Best Practice. (2020). Assessment of Hypertension. London: BMJ Publishing Group Ltd. \nAvailable here.\n\nLast updated March 2021.","Medical professionals situated outside of the United States and Canada. ","This BMJ Best Practice summary on assessment of hypertension includes information on the definition of hypertension, and the variance in defintion between American and British medical bodies. \n\nIt states that the 2017 ACC/AHA guidelines for the prevention, detection, evaluation, and management of high blood pressure in adults defines hypertension as any systolic blood pressure measurement of ≥130 mmHg or any diastolic blood pressure measurement of ≥80 mmHg.[2] ACC/AHA blood pressure categories are defined as follows:\n•Elevated blood pressure: systolic blood pressure of 120-129 mmHg and diastolic blood pressure of <80 mmHg\n•Stage 1 hypertension: systolic blood pressure of 130-139 mmHg and/or diastolic blood pressure of 80-89 mmHg\n•Stage 2 hypertension: systolic blood pressure of ≥140 mmHg and/or diastolic blood pressure of ≥90 mmHg. \n\nEuropean guidelines categorise hypertension as follows:\n•High-normal: systolic 130-139 mmHg and/or diastolic 85-89 mmHg\n•Grade 1: systolic 140-159 mmHg and/or diastolic 90-99 mmHg\n•Grade 2: systolic 160-179 mmHg and/or diastolic 100-109 mmHg\n•Grade 3: systolic ≥180 mmHg and/or diastolic ≥110 mmHg.\n\nThis BMJ Best Practice summary on assessment of hypertension also discusses the epidemiology and complications of hypertension. It also includes information on hypertension and cardiovascular risk. \n\n"]
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[null,"Canllaw ehangach ar atal ffactorau risg ar gyfer pwysedd gwaed uchel:"]
[null,"Ffynhonnell:","Cynulleidfa:","Argymhellion:"]
[null,"National Institute for Health and Care Excellence. Physical activity: encouraging activity in the community. QS183. London: NICE; 2019. Available here. ",null,"This quality standard covers how local strategy, policy and planning and improvements to the built or natural physical environment such as public open spaces, workplaces and schools can encourage and support people of all ages and all abilities to be physically active and move more. It describes high-quality care in priority areas for improvement.\n\n - Statement 1. Local authorities and healthcare commissioning groups have senior level physical activity champions who\n   are responsible for developing and implementing local strategies, policies and plans. \n\n - Statement 2. Local authorities prioritise pedestrians, cyclists and people who use public transport when developing and\n   maintaining connected travel routes.\n\n - Statement 3. Local authorities involve community members in designing and managing public open spaces. \n\n - Statement 4. Workplaces have a physical activity programme to encourage employees to move more and be more \n   physically active.\n\n - Statement 5. Schools and early years settings have active travel plans that are monitored and updated annually.\n"]
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[null,"National Institute for Health and Care Excellence. Community pharmacies: promoting health and wellbeing. NG102. London: NICE; 2018.\nAvailable here.  \n\nUnderpinning evidence reviews:\n\nNational Institute for Health and Care Excellence. Community pharmacy: promoting health and wellbeing. Evidence reviews for providing information on health and wellbeing. Evidence review 1. NICE Guideline NG102; 2018.\nAvailable here.  \n","This guideline is for community pharmacies, local pharmaceutical committees and pharmacy organisations, commissioners of health-promoting interventions including local authorities, clinical commissioning groups and NHS England. Local professional networks, health and wellbeing boards. It may also be relevant for private and voluntary sector organisations providing health-promoting services, people working in related services, for example GP practices and out-of-hours services, members of the public. ","This guideline covers how community pharmacies can help maintain and improve people’s physical and mental health and wellbeing, including people with a long-term condition. It aims to encourage more people to use community pharmacies by integrating them within existing health and care pathways and ensuring they offer standard services and a consistent approach. It requires a collaborative approach from individual pharmacies and their representatives, local authorities and other commissioners. The guideline makes recommendations on:\n\n - Health and wellbeing hub\n - Overarching principles of good practice\n - Awareness raising and providing information\n - Advice and education\n - Behavioural support\n - Referrals and signposting\n\nRecommendation 1.4 on advice and education states that when someone uses pharmacy services to manage a long-term condition, use this as an opportunity to advise them on how to improve their general health and wellbeing. For example, follow recommendations on advice and education in NICE guidelines on: hypertension in adults for people with, or at risk of, hypertension (see the sections on lifestyle interventions and patient education and adherence to treatment). \n\n"]
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[null,"National Institute for Health and Care Excellence. Community pharmacy: promoting health and wellbeing. Evidence reviews for providing information on health and wellbeing. Evidence review 2. NICE Guideline NG102; 2018.\nAvailable here.  \n\nNational Institute for Health and Care Excellence. Community pharmacy: promoting health and wellbeing. Evidence reviews for providing information on health and wellbeing. Evidence review 3. NICE Guideline NG102; 2018.\nAvailable here.  \n\nNational Institute for Health and Care Excellence. Community pharmacy: promoting health and wellbeing. Evidence reviews for providing information on health and wellbeing. Evidence review 4. NICE Guideline NG102; 2018.\nAvailable here.  "]
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[null,"Scottish Intercollegiate Guidelines Network (SIGN). Risk estimation and the prevention of cardiovascular disease. SIGN 149. Edinburgh: SIGN; 2017. \nAvailable here. ","This guideline will be of interest to healthcare professionals involved in the management of patients with\ncardiovascular disease including cardiologists, dietitians, general practitioners, lipidologists, pharmacists,\nphysiotherapists, practice nurses, psychologists and public health staff, as well as patients, carers, voluntary\norganisations and policy makers.","This guideline deals with the management of cardiovascular risk, both primary prevention, defined as the potential for an intervention prior to the disease presenting through a specified event (any incident linked to critical disruption of blood flow that may cause damage to the heart, brain or peripheral tissues), and secondary prevention, defined as the potential for intervention after an event has occurred. \n\nThe guideline provides recommendations on estimation of cardiovascular risk and interventions to reduce this risk in people with and without established cardiovascular disease (CVD). The guideline does not make specific recommendations for the management of people with chronic heart failure, acute coronary syndrome, stable angina or cardiac arrhythmias as these are contained within other SIGN guidelines.\n\nThe guideline includes sections on blood pressure (BP) thresholds, selection of antihypertensive therapy and the British Hypertension Society algorithm (for the selection of drug therapy). \n\nThe guideline recommends that:\n\n - Individuals with uncomplicated hypertension should be supported to achieve a BP target of <140/90 mmHg (clinic measurement)\n - For individuals with established CVD and diabetes, chronic renal disease or target organ damange a lower blood pressure target of <135/85 mmHg (clinic measurement) should be considered\n - Lowering BP below 130/80 mmHg is not routinely recommended as this brings limited additional benefits and causes significant adverse effects\n\n\n"]
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[null,"National Institute for Health and Care Excellence. Obesity in adults: prevention and lifestyle weight management programmes. QS111. London: NICE; 2016. \nAvailable here. ",null,"This quality standard addresses one of the upstream risk factors of hypertension; obesity. Background information in the quality statement states that \"The National Audit Office report Tackling obesity in England estimated that women who are obese are around 13 times more likely to develop type 2 diabetes and 4 times more likely to develop hypertension than women who are not obese. Men who are obese are estimated to be around 5 times more likely to develop type 2 diabetes and 2.5 times more likely to develop hypertension than men who are not obese.\"\n\nThe list of quality statements include:\n\n - Statement 1. Adults using vending machines in local authority and NHS venues can buy healthy food and drink options\n - Statement 2. Adults see details of nutritional information on menus at local authority and NHS venues \n - Statement 3. Adults see healthy food and drink choices displayed prominently in local authority and NHS venues \n - Statement 4. Adults have access to a publicly available, up‑to‑date list of local lifestyle weight management programmes\n - Statement 5. Adults can access data on attendance, outcomes and views of participants and staff from locally commissioned lifestyle weight management programmes \n - Statement 6. Adults identified as being overweight or obese are given information about local lifestyle weight management programmes\n - Statement 7. Adults identified as overweight or obese, with comorbidities are offered a referral to a lifestyle weight management programme\n - Statement 8. Adults about to complete a lifestyle weight management programme agree a plan to prevent weight regain\n"]
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[null,"National Institute for Health and Care Excellence. Preventing excess weight gain. NG7. London: NICE; 2015. \nAvailable here. \n\nUnderpinning evidence review: \n\nBazian Ltd, Johnson L, Sebire S. Maintaining a healthy weight and preventing excess weight gain in children and adults - partial update of CG43. Evidence review 1: An evidence review of modifiable diet and physical activity components, and associated behaviours. London: Bazian, 2014.  \nAvailable here. \n\nBazian Ltd, Johnston L, Sebire S. Maintaining a healthy weight and preventing excess weight gain in children and adults - partial update of CG43. Evidence review 2: Qualitative evidence review of the most acceptable ways to communicate information about individually modifiable behaviours to help maintain a healthy weight or prevent excess weight gain. London: Bazian; 2014.\nAvailable here. \n\n","This guideline is for commissioners and practitioners and members of the public. ","This guideline covers behaviours such as diet and physical activity to help children (after weaning), young people and adults maintain a healthy weight or help prevent excess weight gain. The aim is to prevent a range of diseases and conditions including cardiovascular disease and type 2 diabetes and improve mental wellbeing.\n\nThe guideline makes recommendations on:\n\n - How to encourage people to make changes in line with existing advice\n - How to encourage physical activity and a diet that reduces the risk of excess energy intake\n - Further advice for parents and carers of children and young people\n - How to encourage adults to limit the amount of alcohol they drink\n - How to clearly communicate the benefits of making gradual improvements to physical activity and dietary habits\n - How to tailor messages for specific groups\n - How to ensure activities are integrated with the local strategic approach to obesity\n\nRecommendation 7 advises clearly communicating the broad range of benefits of maintaining a healthy weight through being more physically active and improving dietary habits. These include the reduced risk of developing diseases associated with excess weight such as coronary heart disease, hypertension, liver disease, osteoarthritis, stroke, type 2 diabetes and some cancers. \n"]
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[null,"National Institute for Health and Care Excellence. Weight management: lifestyle services for overweight or obese adults. PH53. London: NICE; 2014. \nAvailable here.\n\nUnderpinning evidence reviews:\n\nHartmann-Boyce J et al. Managing overweight and obesity in adults: update review. The clinical effectiveness of long-term weight management schemes for adults (Review 1a). Oxford: University of Oxford; 2013. \nAvailable here.  ","This guideline is for commissioners, health professionals, providers of lifestyle weight management programmes and adults who are overweight or obese, their families and other members of the public. ","This guideline covers multi-component lifestyle weight management services including programmes, courses, clubs or groups provided by the public, private and voluntary sector. The aim is to help people lose weight and become more physically active to reduce the risk of diseases associated with obesity. This includes coronary heart disease, stroke, type 2 diabetes and various cancers.\n\nThis guideline includes recommendations on:\n\n - How to adopt an integrated approach to preventing and managing obesity\n - Awareness-raising among commissioners, health and social care staff and the public\n - Improve programme uptake, adherence and outcomes\n - Monitoring and evaluation\n"]
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[null,"Hartmann-Boyce J et al. How components of behavioural weight management programmes affect weight change. Review 1b. Oxford: University of Oxford; 2013. \nAvailable here."]
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[null,"Johns D et al. Weight regain after behavioural weight management programmes. Review 1c. Oxford: University of Oxford; 2013. \nAvailable here. "]
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[null,"Johns D et al. Managing overweight and obese adults: evidence review. Review 2. Oxford: University of Oxford; 2013. \nAvailable here. "]
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[null,"National Institute for Health and Care Excellence. Physical activity: exercise referral schemes PH54. London: NICE; 2014. \nAvailable here.\n\nUnderpinning evidence reviews:\n\nCampbell F et al. A systematic review and economic evaluation of exercise referral schemes in primary care: a short report. Sheffield; University of Sheffield school of health and related research; 2013.\nAvailable here.\n\nMorgan F et al. The factors that influence referral to, attendance at and successful completion of exercise schemes and longer term participation in physical activity. Cardiff; Support Unit for Research Evidence (SURE), Cardiff University; 2013.\nAvailable here.","This guideline is for policy makers and commissioners in local authorities and the NHS, primary care practitioners and other practitioners with physical activity as part of their remit. Providers of exercise referral schemes, organisations that provide exercise qualifications and accreditiation, and members of the public. ","This guideline covers exercise referral schemes for people aged 19 and older, in particular, those who are inactive or sedentary. The aim is to encourage people to be physically active.\n\nThis guideline includes recommendations on:\n\n - Exercise referral for people who are sedentary or inactive but otherwise healthy\n - Exercise referral for people who are sedentary or inactive and have a health condition or other health risk factors\n"]
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[null,"National Institute for Health and Care Excellence. Behaviour change: individual approaches PH49, London; NICE. 2014. \nAvailable here.\n\nUnderpinning evidence review:\n\nBazian Ltd. Individual-level behaviour change. External evidence review 1: review of current NICE guidance and recommendations. Bazian; 2012. \nAvailable here.\n\nBazian Ltd. Individual-level behaviour change. External evidence review 2: review of evidence of effectiveness of interventions and behaviour change techniques in individual level interventions. Bazian; 2013. \nAvailable here. \n\nBazian Ltd. Individual-level behaviour change. External evidence review 3: A qualitative review of studies describing the characteristics and competencies needed for behaviour change interventions or techniques. Bazian; 2013.\nAvailable here. ","This guideline is for healthcare professionals, commissioners and providers, young people, adults, their families and carers. ","This guideline covers changing health-damaging behaviours among people aged 16 and over using interventions such as goals and planning, feedback and monitoring, and social support. It aims to help tackle a range of behaviours including alcohol misuse, poor eating patterns, lack of physical activity, unsafe sexual behaviour and smoking. Hypertension is not specifically mentioned but the guideline is applicable for tackling some of the risk factors for hypertension such as lack of physical activity, diet and alcohol misuse. \n\nThis guideline includes recommendations on: \n\n - Developing local behaviour change policy and strategy\n - Commissioning interventions\n - Planning interventions that take account of local needs\n - Ensuring interventions meet individual needs\n - Delivering interventions\n - Commissioning and providing training\n - Monitoring and evaluating interventions\n"]
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[null,"National Institute for Health and Care Excellence. Type 2 diabetes prevention: population and community-level interventions PH35. London: NICE; 2011. \nAvailable here. \n\nUnderpinning evidence review: \n\nNational Institute for Health and Care Excellence. Preventing type 2 diabetes: population and community-level interventions. Evidence update October 2014. London; NICE, 2014. \nAvailable here. ","This guideline is for directors and commissioners, GPs, practice nurses, dietitians and public health nutritionists and other health professionals. Practitioners involved in physical activity interventions and community engagement and members of the public. ","This guideline covers preventing type 2 diabetes in adult populations and communities who are at high risk. It aims to promote a healthy diet and physical activity at community and population level, and recommends how to tailor services for people in ethnic communities and other groups who are particularly at risk of type 2 diabetes.\n\nThis guideline includes recommendations on:\n\n - Integrating national strategy on non-communicable diseases\n - Local joint strategic needs assessments and developing a local strategy\n - Interventions for communities at high risk of type 2 diabetes\n - Conveying messages to the local and whole population\n - Promoting a healthy diet: local and national action\n - Promoting physical activity: local and national action\n - Training those involved in promoting healthy lifestyles\n\n\n"]
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[null,"National Institute for Health and Care Excellence. Cardiovascular disease prevention PH25. London: NICE, 2010.\nAvailable here. \n\nUnderpinning evidence reviews:\n\nNational Institute for Health and Care Excellence. Prevention of cardiovascular disease. Evidence update January 2014. London: NICE, 2014. \nAvailable here. ","This guideline is for national government, NHS and local authorities, industry, commissioners, managers and practitioners working in the above and in the wider public, private, voluntary and community sections, and members of the public. ","This guideline covers the main risk factors linked with CVD:  poor diet, physical inactivity, smoking and excessive alcohol consumption. It aims to reduce the high incidence of CVD. This, in turn, will help prevent other major causes of death and illness, such as type 2 diabetes and many cancers.\n\nThis guideline includes recommendations for policy: a national framework for action and recommendations for practice. Topics covered include:\n\n - How to reduce the nation’s consumption of salt, saturated fats and trans fats\n - Commercial interests\n - Product labelling\n - Public sector catering guidelines\n - Regional CVD prevention programmes\n - Health impact assessments of regional and local plans and policies\n - Take-aways and other food outlets\n\nThe guidance is intended to complement other NICE guidance, including guidance on hypertension.\n\nIn the underpinning evidence review update, one key point states that \"Local policies to reduce intake of salt from foods provided by the public sector might result in fewer cases of hypertension, and corresponding decreases in direct healthcare costs\". It states that \"reducing UK salt intake by 3g/day might prevent approximately 10,000 deaths and 10,000 non-fatal cardiovascular events each year. This would exceed benefits from smoking cessation programmes, weight loss interventions in individuals, and statins. Reduction in salt intake by as little as 1 g/day may be more cost effective than blood pressure-lowering drugs\". \n\nThe underpinning review update also states that \"sugar-sweetened drinks may be associated with an increased risk of incident hypertension, though causality is uncertain. Evidence that artificially sweetened drinks might also be associated with hypertension is conflicting\", however this is not covered within the guideline. "]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: prevention. PH24. London: NICE, 2010. \nAvailable here. \n\nUnderpinning evidence reviews:\n\nNational Institute for Health and Care Excellence. Alcohol-use disorders: preventing harmful drinking. Evidence update March 2014. London: NICE, 2014. \nAvailable here.","This guideline is for commissioners, managers and practitioners working in local authorities, the NHS, education and the wider public, private, voluntary and community sectors, and members of the public.","This guideline covers alcohol problems among people over 10. It aims to prevent and identify such problems as early as possible using a mix of policy and practice. Hypertension is not addressed in this guideline, however alcohol misuse is an upstream risk factor for hypertension. \n\nThis guideline includes recommendations on:\n\n - Price, availability and marketing\n - Licensing\n - Supporting children and young people aged 10 to 15 years \n - Screening young people aged 16 and 17 years and offering them extended brief interventions\n - Screening adults and offering them brief advice and interventions\n - Referral\n"]
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[null,"Scottish Intercollegiate Guidelines Network. Management of Obesity: A national clinical guideline. SIGN 115. Edinburgh: SIGN; 2010. \nAvailable here. ","This guideline will be of particular interest to those working in primary care, secondary and\ntertiary NHS weight management services and those involved in management of services for long term conditions especially diabetes and cardiovascular disease. It will help provide direction for planning at local and national levels and will also be of interest to voluntary sector and commercial weight loss organisations, to patients and the general public.","This SIGN clinical guideline updates and supersedees the previous SIGN guidelines on obesity in adults (SIGN 8,1996) and obesity in children and young people (SIGN 69, 2003). Sections 3-15 focus on adult obesity and sections 16-19 cover childhood obesity. This guideline provides evidence based recommendations on the prevention and treatment of obesity within the clinical setting, in children, young people and adults. The focus of prevention is on primary prevention, defined here as intervention when individuals are at a healthy weight and/or overweight to prevent or delay the onset of obesity. \n\nThe guideline addresses:\n\n\u0083\u0083 - Primary prevention of obesity in children, young people and adults\n\u0083\u0083 - Treatment of overweight/obesity by diet and lifestyle interventions\n\u0083\u0083 - Treatment of obesity by pharmacological therapy and bariatric surgery\n\u0083\u0083 - Prevention of weight regain following treatment\n\nThe guideline recommends that healthcare professionals shoud make patients aware of the health benefits associated with sustained modest weight loss, including reduced blood pressure. \n\nThe guideline states that Weight cycling is associated with increased risk of hypertension in obese women. There was\nno adverse effect of weight cycling on hypertension in overweight middle aged men and adverse effects on hypertension in overweight women did not reach statistical significance. Patients should be encouraged to make sustainable lifestyle changes and given support to avoid weight cycling. \n\n"]
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[null,"National Institute for Health and Care Excellence. Cardiovascular disease: identifying and supporting people most at risk of dying early. PH15. London: NICE; 2008.\nAvailable here. ","This guideline is for health and social care practitioners, organisations planning, providing or supporting services that support disadvantaged people, adults with a high risk of heart disease, their families and carers and the general public. ","This guideline covers the risk of early death from heart disease and other smoking-related illnesses. It aims to reduce the number of people who are disadvantaged dying prematurely by ensuring people have better access to flexible, well-coordinated treatment and support.\n\nThis guideline includes recommendations on:\n\n - Identifying adults at risk of early death from heart disease\n - Improving access to services\n - Ensuring services work together\n - Training for staff\n"]
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[null,"National Institute for Health and Care Excellence. Behaviour change: general approaches PH6. London: NICE; 2007.\nAvailable here.\n\nUnderpinning evidence review:\n\nJepson et al. A review of the effectiveness of interventions, approaches and models at individual, community and population level that are aimed at changing health outcomes through changing knowledge attitudes and behaviour. Stirling: University of Stirling: 2006. Available here.","This guideline is for national policy makers, commissioners, providers and practitioners in the NHS, local authorities and the community and voluntary sectors. Researchers, including those who oversee research funding. Social and behavioural scientists, and health economists working on health-related knowledge, attitude and behaviour change.\n","This guideline covers a set of principles that can be used to help people change their behaviour. The aim is for practitioners to use these principles to encourage people to adopt a healthier lifestyle by, for example, stopping smoking, adopting a healthy diet and being more physically active. The guidance does not specifically address hypertension, but is addressing behaviour change interventions for reducing some of the upstream risk factors of hypertension (such as lack of physical activity). \n\nThis guideline recommends a set of principles to use as the basis for:\n\n - Providing education and training for those delivering them\n - Delivery of these activities, including one-to-one and community-based programmes and those aimed at specific populations\n - Evaluation of their effectiveness and cost effectiveness\n"]
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[null,"National Institute for Health and Care Excellence. Obesity Prevention. CG43. London: NICE; 2006. \nAvailable here. \n\nLast updated March 2015.","This guideline is for healthcare professionals, commissioners and providers, employers, local authorities, primary care trusts, head teachers and chairs of governors, children, young people and adults, and their families and carers. ","This guideline covers preventing children, young people and adults becoming overweight or obese. It outlines how the NHS, local authorities, early years’ settings, schools and workplaces can increase physical activity levels and make dietary improvements among their target populations.\n\nThis guideline includes recommendations on:\n\n - Strategies for senior managers and budget holders in the NHS\n - Interventions by healthcare professionals\n - Strategies for senior managers and budget holders in local authorities\n - Interventions by local authorities\n - Interventions in early years’ settings and by teachers\n - Strategies for head teachers and chairs of governors\n - Interventions in workplaces\n"]
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[null,"Adolygiadau systemataidd"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Cormick  G, et al. Calcium supplementation for prevention of primary hypertension. Cochrane Database of Systematic Reviews 2021, Issue 8. Art. No.: CD010037. DOI: 10.1002/14651858.CD010037.pub3. Accessed 07 September 2021.\nAvailable here","Normotensive people of different ages, but excluding pregnant women.","The objective of this Cochrane review was to assess the efficacy and safety of calcium supplementation versus placebo or control for reducing blood pressure in normotensive people and for the prevention of primary hypertension.\nThe authors included a total of 20 trials with 3512 participants, however only 18 were included for the meta-analysis with 3140 participants.\n\nThe effect on systolic and diastolic blood pressure was: mean difference (MD) ‐1.37 mmHg, 95% confidence interval (CI) ‐2.08, ‐0.66; 3140 participants; 18 studies; I2 = 0%, high‐certainty evidence; and MD ‐1.45, 95% CI ‐2.23, ‐0.67; 3039 participants; 17 studies; I2 = 45%, high‐certainty evidence, respectively. \n\nThe effect on systolic and diastolic blood pressure for those younger than 35 years was: MD ‐1.86, 95% CI ‐3.45, ‐0.27; 452 participants; eight studies; I2 = 19%, moderate‐certainty evidence; MD ‐2.50, 95% CI ‐4.22, ‐0.79; 351 participants; seven studies ; I2 = 54%, moderate‐certainty evidence, respectively.\n\nThe effect on systolic and diastolic blood pressure for those 35 years or older was: MD ‐0.97, 95% CI ‐1.83, ‐0.10; 2688 participants; 10 studies; I2 = 0%, high‐certainty evidence; MD ‐0.59, 95% CI ‐1.13, ‐0.06; 2688 participants; 10 studies; I2 = 0%, high‐certainty evidence, respectively. \n\nThe effect on systolic and diastolic blood pressure for women was: MD ‐1.25, 95% CI ‐2.53, 0.03; 1915 participants; eight studies; I2 = 0%, high‐certainty evidence; MD ‐1.04, 95% CI ‐1.86, ‐0.22; 1915 participants; eight studies; I2 = 4%, high‐certainty evidence, respectively.\n \nThe effect on systolic and diastolic blood pressure for men was MD ‐2.14, 95% CI ‐3.71, ‐0.59; 507 participants; five studies; I2 = 8%, moderate‐certainty evidence; MD ‐1.99, 95% CI ‐3.25, ‐0.74; 507 participants; five studies; I2 = 41%, moderate‐certainty evidence, respectively. The effect was consistent in both genders regardless of baseline calcium intake. \n\nThe effect on systolic blood pressure was: MD ‐0.02, 95% CI ‐2.23, 2.20; 302 participants; 3 studies; I2 = 0%, moderate‐certainty evidence with doses less than 1000 mg; MD ‐1.05, 95% CI ‐1.91, ‐0.19; 2488 participants; 9 studies; I2 = 0%, high‐certainty evidence with doses 1000 to 1500 mg; and MD ‐2.79, 95% CI ‐4.71, 0.86; 350 participants; 7 studies = 8; I2 = 0%, moderate‐certainty evidence with doses more than 1500 mg. The effect on diastolic blood pressure was: MD ‐0.41, 95% CI ‐2.07, 1.25; 201 participants; 2 studies; I2 = 0, moderate‐certainty evidence; MD ‐2.03, 95% CI ‐3.44, ‐0.62 ; 1017 participants; 8 studies; and MD ‐1.35, 95% CI ‐2.75, ‐0.05; 1821 participants; 8 studies; I2 = 51%, high‐certainty evidence, respectively.\n\n\n\n","An increase in calcium intake slightly reduces both systolic and diastolic blood pressure in normotensive people, particularly in young people, suggesting a role in the prevention of hypertension. The effect across multiple prespecified subgroups and a possible dose response effect reinforce this conclusion. Even small reductions in blood pressure could have important health implications for reducing vascular disease. A 2 mmHg lower systolic blood pressure is predicted to produce about 10% lower stroke mortality and about 7% lower mortality from ischaemic heart disease. \n\nThere is a great need for adequately‐powered clinical trials randomising young people. Subgroup analysis should involve basal calcium intake, age, sex, basal blood pressure, and body mass index. Also required is assessment of side effects, optimal doses and the best strategy to improve calcium intake.\n"]
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[null,"Chastin  S, et al. Interventions for reducing sedentary behaviour in community‐dwelling older adults. Cochrane Database of Systematic Reviews 2021, Issue 6. Art. No.: CD012784. DOI: 10.1002/14651858.CD012784.pub2. Accessed 07 September 2021.\nAvailable here","Older adults (aged 60 or over) living independently in the community. Participants having multiple comorbidities were included, but the authors excluded interventions that recruited clinical populations specifically (e.g. stroke survivors).","The aim of this Cochrane review was to evaluate the effectiveness of interventions aimed at reducing sedentary behaviour amongst older adults living independently in the community compared to control conditions involving either no intervention or interventions that do not target sedentary behaviour.\nThe evidence suggests that interventions to change sedentary behaviour in community‐dwelling older adults may reduce sedentary time (mean difference (MD) −44.91 min/day, 95% confidence interval (CI) −93.13 to 3.32; 397 participants; 7 studies; I2 = 73%; low‐certainty evidence). The authors could not pool evidence on the effect of interventions on breaks in sedentary behaviour or time spent in specific domains such as TV time, as data from only one study were available for these outcomes.\nThe authors are uncertain whether interventions to reduce sedentary behaviour have any impact on the physical or mental health outcomes of community‐dwelling older adults. They were able to pool change data for the following outcomes:\nBlood pressure: systolic (MD −3.91 mmHg, 95% CI ‐10.95 to 3.13; 138 participants; 3 studies; I2 = 73%; very low‐certainty evidence) and diastolic (MD −0.06 mmHg, 95% CI −5.72 to 5.60; 138 participants; 3 studies; I2 = 97%; very low‐certainty evidence).","It is not clear whether interventions to reduce sedentary behaviour are effective at reducing sedentary time in community‐dwelling older adults. The authors are uncertain if these interventions have any impact on the physical or mental health of community‐dwelling older adults. There were few studies, and the certainty of the evidence is very low to low, mainly due to inconsistency in findings and imprecision.\nFuture studies should consider interventions aimed at modifying the environment, policy, and social and cultural norms. Future studies should also use device‐based measures of sedentary time, recruit larger samples, and gather information about quality of life, cost‐effectiveness, and adverse event data."]
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[null,"Rees K et al. Vegan dietary pattern for the primary and secondary prevention of cardiovascular diseases. Cochrane Database of Systematic Reviews 2021, Issue 2. Art. No.: CD013501.\nAvailable here\n","Adults (≥ 18 years of age) from the general population and those at high risk of CVD to examine primary prevention, and those with established CVD to examine secondary prevention.","The authors included thirteen RCTs (38 papers, 7 trial registrations) and eight ongoing trials. \nThe authors conducted three main comparisons:\n1. Vegan dietary intervention versus no intervention or minimal intervention for primary prevention; 2. Vegan dietary intervention versus another dietary intervention for primary prevention; \n3. Vegan dietary intervention versus another dietary intervention for secondary prevention.\nMost trials contributed to primary prevention: comparisons 1 (four trials, 466 participants randomised) and comparison 2 (eight trials, 409 participants randomised). They included only one secondary prevention trial for comparison 3 (63 participants randomised).\nFor comparison 1, there was a lack of evidence for an effect with the vegan dietary intervention on systolic blood pressure (MD 0.94 mmHg, 95% CI −1.18 to 3.06; 3 trials, 374 participants) and diastolic blood pressure (MD−0.27 mmHg, 95% CI −1.67 to 1.12; 3 trials, 372 participants) (low-certainty evidence).\nFor comparison 2 the authors are very uncertain about any effect of the vegan dietary intervention on systolic blood pressure (MD 0.02 mmHg, 95% CI −3.59 to 3.62) or diastolic blood pressure (MD 0.63 mmHg, 95% CI −1.54 to 2.80; 5 trials,247 participants (very low-certainty evidence)).\nOnly one trial (63 participants) contributed to comparison 3, where there was a lack of evidence for an effect of the vegan dietary intervention on lipid levels or blood pressure compared to other dietary interventions (low- or very low-certainty evidence).","Studies were generally small with few participants contributing to each comparison group. None of the included studies report on CVD clinical events. There is currently insufficient information to draw conclusions about the effects of vegan dietary interventions on CVD risk factors. The eight ongoing studies identified will add to the evidence base, with all eight reporting on primary prevention. There is a paucity of evidence for secondary prevention."]
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[null,"Palmer MJ et al. Mobile phone-based interventions for improving adherence to medication prescribed for the primary prevention of cardiovascular disease in adults. Cochrane Database of Systematic Reviews 2021, Issue 3. Art. No.: CD012675.\nAvailable here","Adults (aged 18 years and over) who have been prescribed medication for the primary prevention of CVD.","The authors included 14 trials with 25,633 randomised participants. Participants were from community-based primary and tertiary care or outpatient clinics. The interventions varied from short messaging service (SMS) to those involving a combination of modes of delivery, such as SMS in addition to healthcare worker training, face-to-face counselling, electronic pillboxes, written materials, and home blood pressure monitors. Some interventions only targeted medication adherence, while others additionally targeted lifestyle changes such as diet and exercise.\n\nAcross 13 studies (25,166 participants) measuring systolic blood pressure, effect estimates ranged from a large reduction (MD −12.45 mmHg,95% CI−15.02 to −9.88) to a small increase (MD 2.80 mmHg, 95% CI 0.30 to 5.30). The authors found a similar range of effect estimates for diastolic BP, ranging from −12.23 mmHg (95% CI −14.03 to −10.43) to 1.64 mmHg (95% CI −0.55 to 3.83) (11 trials, 19,716 participants). Four trials showed intervention benefits for systolic and diastolic BP with confidence intervals excluding no effect, and among these were all three of the trials evaluating self-monitoring of blood pressure with mobile phone-based telemedicine. Pooled analyses of the two trials of interventions solely delivered through SMS were indicative of little or no beneficial intervention effect on systolic BP (MD −1.55 mmHg, 95% CI −3.36 to 0.25; I2 = 0%) and small increases in controlled BP (OR 1.32, 95% CI 1.06 to 1.65; I2 = 0%).","There is low-certainty evidence on the effects of mobile phone-delivered interventions to increase adherence to medication prescribed for the primary prevention of CVD. Trials of BP self-monitoring with mobile-phone telemedicine support reported modest benefits. One trial at low risk of bias reported modest reductions in LDL cholesterol but no benefits for BP. There is moderate-certainty evidence that these interventions do not result in harm. Further trials of these interventions are warranted."]
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[null,"Lee  L-L, et al. Walking for hypertension. Cochrane Database of Systematic Reviews 2021, Issue 2. Art. No.: CD008823. DOI: 10.1002/14651858.CD008823.pub2.\nAvailable here.","General population, aged from 16 to 84 years (approximately 1.5 times as many females as males). ","This systematic review sought to determine the effect of walking as a physical activity intervention on blood pressure and heart rate.\nThe authors included 73 trials, with 5763 participants in total; studies were undertaken in 22 countries. The majority of walking interventions were at home/community (n = 50) but supervised (n = 36 out of 47); the average intervention length was 15 weeks, average walking time per week was 153 minutes and the majority of walking intensity was moderate.\nThe authors found moderate‐certainty evidence suggesting that walking reduces systolic blood pressure (SBP) (MD ‐4.11 mmHg, 95% CI ‐5.22 to ‐3.01; 73 studies, n = 5060). They found moderate‐certainty evidence suggesting that walking reduces SBP in participants aged 40 years and under (MD ‐4.41 mmHg, 95% CI ‐6.17 to ‐2.65; 14 studies, n = 491), and low‐certainty evidence that walking reduces SBP in participants aged 41 to 60 years (MD ‐3.79 mmHg, 95% CI ‐5.64 to ‐1.94, P < 0.001; 35 studies, n = 1959), and those aged 60 years of over (MD ‐4.30 mmHg, 95% CI ‐6.17 to ‐2.44, 24 studies, n = 2610). The authors also found low certainty‐evidence suggesting that walking reduces SBP in both females (MD ‐5.65 mmHg, 95% CI ‐7.89 to ‐3.41; 22 studies, n = 1149) and males (MD ‐4.64 mmHg, 95% CI ‐8.69 to ‐0.59; 6 studies, n = 203).\nThe authors found low‐certainty evidence suggesting that walking reduces diastolic blood pressure (DBP) (MD ‐1.79 mmHg, 95% CI ‐2.51 to ‐1.07; 69 studies, n = 4711) and heart rate (MD ‐2.76 beats per minute (bpm), 95% CI ‐4.57 to ‐0.95; 26 studies, n = 1747). They found moderate‐certainty evidence suggesting that walking reduces DBP for participants aged 40 years and under (MD ‐3.01 mmHg, 95% CI ‐4.44 to ‐1.58; 14 studies, n = 491) and low‐certainty evidence suggesting that walking reduces DBP for participants aged 41 to 60 years (MD ‐1.74 mmHg, 95% CI ‐2.95 to ‐0.52; 32 studies, n = 1730) and those aged 60 years and over (MD ‐1.33 mmHg, 95% CI ‐2.40 to ‐0.26; 23 studies, n = 2490). The authors found moderate‐certainty evidence that suggests walking reduces DBP for males (MD ‐2.54 mmHg, 95% CI ‐4.84 to ‐0.24; 6 studies, n = 203) and low‐certainty evidence that walking reduces DBP for females (MD ‐2.69 mmHg, 95% CI ‐4.16 to ‐1.23; 20 studies, n = 1000). Only 21 included studies reported adverse events. Of these 21 studies, 16 reported no adverse events, the remaining five studies reported eight adverse events, with knee injury being reported five times.\n","Moderate‐certainty evidence suggests that walking probably reduces SBP. Moderate‐ or low‐certainty evidence suggests that walking may reduce SBP for all ages and both sexes. Low‐certainty evidence suggests that walking may reduce DBP and heart rate. Moderate‐ and low‐certainty evidence suggests walking may reduce DBP and heart rate for all ages and both sexes."]
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[null,"Semlitsch T, et al. A. Long‐term effects of weight‐reducing diets in people with hypertension. Cochrane Database of Systematic Reviews 2021, Issue 2. Art. No.: CD008274. DOI: 10.1002/14651858.CD008274.pub4. \nAvailable here.","Adults with primary hypertension.","This second update of a systematic review first published in 2011 aimed to assess the long‐term effects of weight‐reducing diets in people with hypertension on all‐cause mortality, cardiovascular morbidity, and adverse events (including total serious adverse events, withdrawal due to adverse events, and total non‐serious adverse events). A secondary objective was to assess the long‐term effects of weight‐reducing diets in people with hypertension on change from baseline in systolic blood pressure, change from baseline in diastolic blood pressure, and body weight reduction.\nThis second review update did not reveal any new trials, so the number of included trials remains the same: eight RCTs involving a total of 2100 participants with high blood pressure and a mean age of 45 to 66 years. Mean treatment duration was 6 to 36 months. One RCT evaluated the effects of dietary weight loss on a combined endpoint consisting of the necessity of reinstating antihypertensive therapy and severe cardiovascular complications. In this RCT, weight‐reducing diet lowered the endpoint compared to no diet: hazard ratio 0.70 (95% confidence interval (CI) 0.57 to 0.87). The certainty of the evidence was low for a blood pressure reduction in participants assigned to weight‐loss diets as compared to controls: systolic blood pressure: mean difference (MD) −4.5 mm Hg (95% CI −7.2 to −1.8 mm Hg) (3 studies, 731 participants), and diastolic blood pressure: MD −3.2 mm Hg (95% CI −4.8 to −1.5 mm Hg) (3 studies, 731 participants). The authors judged the certainty of the evidence to be high for weight reduction in dietary weight loss groups as compared to controls: MD −4.0 kg (95% CI −4.8 to −3.2) (5 trials, 880 participants). Two trials used withdrawal of antihypertensive medication as their primary outcome. Even though the authors did not consider this a relevant outcome for our review, the results of these RCTs strengthen the finding of a reduction of blood pressure by dietary weight‐loss interventions.\n","In this second update, the conclusions remain unchanged, as the authors found no new trials. In people with primary hypertension, weight‐loss diets reduced body weight and blood pressure, but the magnitude of the effects are uncertain due to the small number of participants and studies included in the analyses. Whether weight loss reduces mortality and morbidity is unknown. No useful information on adverse effects was reported in the relevant trials."]
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[null,"Graudal NA et al. Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride. Cochrane Database of Systematic Reviews 2020, Issue 12. Art. No.: CD004022. DOI: 10.1002/14651858.CD004022.pub5.\nAvailable here","The authors compared normotensive and hypertensive populations in White, Black and Asian populations; mostly adults some adolescents. ","This update of a 2017 Cochrane review (first published 2003) aimed to assess the effects of sodium reduction on blood pressure, and on potential side‐effects (hormones and lipids). Since the first review in 2003 the number of included references has increased from 96 to 195 (174 were in white participants). As a previous study found different blood pressure outcomes in black and white study populations, the authors stratified the BP outcomes by race.\n\nThe effect of sodium reduction (from 203 to 65 mmol/day) on BP in white participants was as follows: Normal blood pressure: SBP: mean difference (MD) ‐1.14 mmHg (95% confidence interval (CI): ‐1.65 to ‐0.63), 5982 participants, 95 trials; DBP: MD + 0.01 mmHg (95% CI: ‐0.37 to 0.39), 6276 participants, 96 trials. Hypertension: SBP: MD ‐5.71 mmHg (95% CI: ‐6.67 to ‐4.74), 3998 participants,88 trials; DBP: MD ‐2.87 mmHg (95% CI: ‐3.41 to ‐2.32), 4032 participants, 89 trials (all high‐quality evidence).\n\nThe effect of sodium reduction (from 195 to 66 mmol/day) on BP in black participants was as follows: Normal blood pressure: SBP: mean difference (MD) ‐4.02 mmHg (95% CI:‐7.37 to ‐0.68); DBP: MD ‐2.01 mmHg (95% CI:‐4.37, 0.35), 253 participants, 7 trials. Hypertension: SBP: MD ‐6.64 mmHg (95% CI:‐9.00, ‐4.27); DBP: MD ‐2.91 mmHg (95% CI:‐4.52, ‐1.30), 398 participants, 8 trials (low‐quality evidence).\n\nThe effect of sodium reduction (from 217 to 103 mmol/day) on BP in Asian participants was as follows: Normal blood pressure: SBP: mean difference (MD) ‐1.50 mmHg (95% CI: ‐3.09, 0.10); DBP: MD ‐1.06 mmHg (95% CI:‐2.53 to 0.41), 950 participants, 5 trials. Hypertension: SBP: MD ‐7.75 mmHg (95% CI:‐11.44, ‐4.07); DBP: MD ‐2.68 mmHg (95% CI: ‐4.21 to ‐1.15), 254 participants, 8 trials (moderate‐low‐quality evidence).\n","In white participants, sodium reduction in accordance with the public recommendations resulted in mean arterial pressure (MAP) decrease of about 0.4 mmHg in participants with normal blood pressure and a MAP decrease of about 4 mmHg in participants with hypertension. Weak evidence indicated that these effects may be a little greater in black and Asian participants. The effects of sodium reduction on potential side effects (hormones and lipids) were more consistent than the effect on BP, especially in people with normal BP."]
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[null,"Hooper  L, et al. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database of Systematic Reviews 2020, Issue 8. Art. No.: CD011737. DOI: 10.1002/14651858.CD011737.pub3. Available here.","Adults (18 years or older), with and without cardiovascular disease.","The authors sought to assess the effect of reducing saturated fat intake and replacing it with carbohydrate (CHO), polyunsaturated (PUFA), monounsaturated fat (MUFA) and/or protein on mortality and cardiovascular morbidity.\nThey included trials that used a variety of interventions from providing all food to advice on reducing saturated fat. The included long‐term trials suggested that reducing dietary saturated fat reduced the risk of combined cardiovascular events by 17% (risk ratio (RR) 0.83; 95% confidence interval (CI) 0.70 to 0.98, 12 trials, 53,758 participants of whom 8% had a cardiovascular event, I² = 67%, GRADE moderate‐quality evidence). Meta‐regression suggested that greater reductions in saturated fat (reflected in greater reductions in serum cholesterol) resulted in greater reductions in risk of CVD events, explaining most heterogeneity between trials. The number needed to treat for an additional beneficial outcome (NNTB) was 56 in primary prevention trials, so 56 people need to reduce their saturated fat intake for four years for one person to avoid experiencing a CVD event. In secondary prevention trials, the NNTB was 53. Subgrouping did not suggest significant differences between replacement of saturated fat calories with polyunsaturated fat or carbohydrate, and data on replacement with monounsaturated fat and protein was very limited. \n\nThe authors found little or no effect of reducing saturated fat on all‐cause mortality (RR 0.96; 95% CI 0.90 to 1.03; 11 trials, 55,858 participants) or cardiovascular mortality (RR 0.95; 95% CI 0.80 to 1.12, 10 trials, 53,421 participants), both with GRADE moderate‐quality evidence. \n\nThere was little or no effect of reducing saturated fats on non‐fatal myocardial infarction (RR 0.97, 95% CI 0.87 to 1.07) or CHD mortality (RR 0.97, 95% CI 0.82 to 1.16, both low‐quality evidence), but effects on total (fatal or non‐fatal) myocardial infarction, stroke and CHD events (fatal or non‐fatal) were all unclear as the evidence was of very low quality. There was little or no effect on cancer mortality, cancer diagnoses, diabetes diagnosis, HDL cholesterol, serum triglycerides or blood pressure, and small reductions in weight, serum total cholesterol, LDL cholesterol and BMI. There was no evidence of harmful effects of reducing saturated fat intakes.","The findings of this updated review suggest that reducing saturated fat intake for at least two years causes a potentially important reduction in combined cardiovascular events. Replacing the energy from saturated fat with polyunsaturated fat or carbohydrate appear to be useful strategies, while effects of replacement with monounsaturated fat are unclear. \nThe reduction in combined cardiovascular events resulting from reducing saturated fat did not alter by study duration, sex or baseline level of cardiovascular risk, but greater reduction in saturated fat caused greater reductions in cardiovascular events."]
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[null,"Acin MT et al. Alcohol intake reduction for controlling hypertension. Cochrane Database of Systematic Reviews 2020, Issue 9. Art. No.: CD010022. DOI: 10.1002/14651858.CD010022.pub2. \nAvailable here.","Participants were adults (16 years of age or older) with systolic blood pressure (SBP) greater than 140 mmHg and diastolic blood pressure (DBP) greater than 90 mmHg, and SBP ≥ 130 or DBP ≥ 80 mmHg in participants with diabetes. ","The authors sought to assess the effect of any intervention to reduce alcohol intake in terms of blood pressure decrease in hypertensive people with alcohol consumption compared to a control intervention or no intervention at all. The authors included one trial with 269 participants, followed up for 24 months. They assessed data to identify differences in blood pressure, number of deaths and serious diseases between a group of people receiving psychological assistance (in the form of cognitive behavioural therapy) to reduce alcohol intake and people not receiving this assistance.\nNo differences were found between the cognitive-behavioural intervention group and the control group for overall mortality (RR 0.72, 95%CI 0.16 to 3.17; low-certainty evidence), cardiovascular mortality (not estimable) and cardiovascular events (RR 0.80, 95% CI 0.36 to 1.79; very low-certainty evidence). There was no statistical difference in systolic blood pressure (SBP) reduction (Mean Difference (MD) -0.92mmHg, 95% confidence interval (CI) -5.66 to 3.82 mmHg; very low-certainty evidence) or diastolic blood pressure (DBP) decrease (MD 0.98mmHg, 95% CI -1.69 to 3.65 mmHg; low-certainty evidence) between the cognitive behavioural intervention group and the control group. The authors did not find any differences in the proportion of subjects with SBP < 140 mmHg and DBP < 90 mmHg (Risk Ratio (RR) 1.21, 95%CI 0.88 to 1.65; very low-certainty evidence).","An intervention for decreasing alcohol intake consumption did not result in differences in systolic and diastolic blood pressure when compared with a control intervention, although there was a reduction in alcohol intake favouring the active intervention. No differences were found either for overall mortality, cardiovascular mortality or cardiovascular events. No data on serious adverse events or quality of life were available to assess. Adequate randomised controlled trials are needed to provide additional evidence on this specific question."]
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[null,"Freak-Poli  RLA, et al. Workplace pedometer interventions for increasing physical activity. Cochrane Database of Systematic Reviews 2020, Issue 7. Art. No.: CD009209. DOI: 10.1002/14651858.CD009209.pub3. \nAvailable here.","Employed adults. Participants included both healthy populations and those at risk of chronic disease (e.g. through inactivity or overweight), with a mean age of 41 years.","The authors sought to assess the effectiveness of pedometer interventions in the workplace for increasing physical activity and improving long-term health outcomes. They included 14 studies, recruiting a total of 4762 participants. These studies were conducted in various high-income countries and in diverse workplaces (from offices to physical workplaces). \n\nWhen pedometer interventions are compared to minimal interventions at follow-up points at least one month after completion of the intervention, pedometers may have no effect on physical activity (6 studies; very low-certainty evidence; no meta-analysis due to very high heterogeneity), but the effect is very uncertain. Pedometers may have effects on sedentary behaviour but these effects were very uncertain (1 study; very low-certainty evidence). Pedometer interventions probably had little to no effect on blood pressure (systolic: -0.08 mmHg, 95%CI -3.26 to 3.11; 2 studies; moderate-certainty evidence). \n\nComparison of pedometer interventions to alternative physical activity interventions at follow-up points at least one month after completion of the intervention revealed that pedometers may have an effect on physical activity, but the effect is very uncertain (1 study; very low-certainty evidence). Sedentary behaviour and blood pressure (systolic or diastolic were not compared to an alternative physical activity intervention.\n","Exercise interventions can have positive effects on employee physical activity and health, although current evidence is insufficient to suggest that a pedometer-based intervention would be more effective than other options. It is important to note that over the past decade, technological advancement in accelerometers as commercial products, often freely available in Smartphones, has in many ways rendered the use of pedometers outdated. Future studies aiming to test the impact of either pedometers or accelerometers would likely find any control arm highly contaminated.\nDecision-makers considering allocating resources to large-scale programmes of this kind should be cautious about the expected benefits of incorporating a pedometer and should note that these effects may not be sustained over the longer term. \nFuture studies should be designed to identify the effective components of multi-component interventions, although pedometers may not be given the highest priority (especially considering the increased availability of accelerometers). Approaches to increase the sustainability of intervention effects and behaviours over a longer term should be considered, as should more consistent measures of physical activity and health outcomes.\nPedometers are now being largely replaced by more sophisticated devices such as accelerometers and Smartphone apps. For this reason, this is the final update of this review.\n"]
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[null,"Schmidt  B-M, et al. Screening strategies for hypertension. Cochrane Database of Systematic Reviews 2020, Issue 5. Art. No.: CD013212. DOI: 10.1002/14651858.CD013212.pub2.\nAvailable here.","Healthy adolescents, adults, and elderly people participating in mass, targeted, or opportunistic screening of hypertension.","The authors screened 9335 titles and abstracts. They identified 54 potentially eligible studies for full‐text screening. However, no studies met the eligibility criteria.\n\nDue to identified gaps in the current evidence base, the authors are unable to highlight clear implications for Hypertension screening policy.","There is an implicit assumption that early detection of hypertension through screening can reduce the burden of morbidity and mortality, but this assumption has not been tested in rigorous research studies.\n \nHigh‐quality evidence from RCTs or programmatic evidence from NRCTs on the effectiveness and costs or harms of different screening strategies for hypertension (mass, targeted, or opportunistic) to reduce hypertension‐related morbidity and mortality is lacking."]
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[null,"Ellwood, L et al. Effects of flavonoid-rich fruits on hypertension in adults: a systematic review. JBI Database of Systematic Reviews and Implementation Reports: October 2019 - Volume 17 - Issue 10 - p 2075-2105 doi: 10.11124/JBISRIR-D-19-00050\nAvailable here","Participants aged 18 years and over with primary, secondary or malignant hypertension.","Six trials investigated the effect of the flavonoid intervention on blood pressure within four weeks. Meta-analysis of four of the trials demonstrated no effect of flavonoids on systolic or diastolic blood pressure when compared to placebo (systolic mean difference = −1.02, 95% confidence interval [CI] −3.12, 1.07; p = 0.34, I2 = 0%; diastolic mean difference = −0.90, 95% CI −2.10, 0.31; p = 0.15, I2 = 0%). Similarly, pooled results from two crossover RCTs with two-timed dosed interventions in a 24-hour period demonstrated no effect on a reduction in diastolic blood pressure (p = 0.38) but did reveal evidence of a reduction in systolic blood pressure (p = 0). Six trials assessed blood pressure following the flavonoid intervention at more than four weeks follow-up. Meta-analysis of five of the trials demonstrated evidence of no effect on either systolic blood pressure (mean difference = −0.95, 95%CI −3.58, 1.68; p = 0.478, I2 = 0%) or diastolic blood pressure (mean difference = 0.86, 95%CI −1.11, 2.82; p = 0.393, I2 = 0%).","The findings of this systematic review should be interpreted with caution, given that the results are obtained from single-center trials with small sample sizes. Flavonoids have no effect on systolic and diastolic blood pressure. \nFurther robust RCTs using sample sizes based on power calculations are needed to provide evidence for the use of flavonoid-rich fruits for the management of hypertension."]
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[null,"Remington, J and Winters, K. Effectiveness of dietary inorganic nitrate for lowering blood pressure in hypertensive adults: a systematic review, JBI Database of Systematic Reviews and Implementation Reports: March 2019 - Volume 17 - Issue 3 - p 365-389 doi: 10.11124/JBISRIR-2017-003842.\nAvailable here\n","Adults aged 18 years and over, with blood pressure greater than 120/80 mmHg, undergoing interventions focusing on the effects of inorganic nitrate on blood pressure.","Twelve papers were included in the systematic review with a total of 321 participants. Ten were randomized controlled trials and two were quasi-experimental studies. All participants had baseline blood pressures greater than 120/80 mmHg. Some studies included participants with comorbidities such as diabetes or heart failure with preserved ejection fraction. Inorganic nitrate was administered multiple ways throughout the studies including the following: beetroot juice, beetroot gel, nitric oxide lozenge, high nitrate diet, and raw and cooked beet juice. Doses and treatment intervals varied. Some studies included exercise as part of the intervention protocol.\n\nMeta-analysis was not conducted due to heterogeneity that existed within the studies. Blood pressure was measured in multiple settings by manual, digital or ambulatory means. The noted outcome patterns were as follows: no change in systolic blood pressure and diastolic blood pressure, decrease in systolic blood pressure and diastolic blood pressure, or decrease in systolic blood pressure with no change in diastolic blood pressure. Possible reasons for the diverse findings include the following: age, comorbidities, use of antihypertensives by participants; source and dose of nitrate; and intervention and follow-up time frames.\n","There is insufficient evidence to support or refute the use of inorganic nitrate for any effect on blood pressure at this time. Therefore, there is no concrete base for the development of practice guidelines until stronger evidence becomes available. The gaps in the literature along with the study limitations identified necessitate the need for more research on inorganic nitrate and how it relates to blood pressure."]
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[null,"Steed  L et al. Community pharmacy interventions for health promotion: effects on professional practice and health outcomes. Cochrane Database of Systematic Reviews 2019, Issue 12. Art. No.: CD011207.\nAvailable here.","Pharmacy workers, including pharmacists and counter assistants; adult pharmacy users with varying health conditions including: hypertension, diabetes, cardiovascular disease and dyslipidemia. ","The aim of this Cochrane review was to assess the effectiveness and safety of health‐promotion interventions to change community pharmacy workers' professional practice and improve outcomes for users of community pharmacies.\n\nThe authors included 57 randomised trials with 16,220 participants, described in 83 reports. Most interventions were educational, or incorporated skills training. Interventions were directed at pharmacy workers (n = 8), pharmacy users (n = 13), or both (n = 36). The clinical areas most frequently studied were diabetes, hypertension, asthma, and modification of cardiovascular risk. \n\nMost studies (47 of 57) were directed towards secondary prevention of conditions, including cardiovascular disease (1 study), type 2 diabetes (10 studies), dyslipidaemia (4 studies), and hypertension (4 studies). In approximately half of these conditions the intervention was described as being focused on the pharmacy user, whilst the other half mentioned some degree of training for the community pharmacy workers. \n\nThe authors conducted subgroup analyses for different patient behaviours, clinical conditions, and generic versus specific quality of life measures. When analysing the data across studies, when there were related outcomes from the same study, the authors used the most clinically rigorous measure. For hypertension this was: systolic blood pressure followed by diastolic blood pressure. Sub‐group analyses separated by condition suggested that interventions probably improve blood pressure in hypertension (SMD ‐0.34, 95% CI ‐0.49 to ‐0.18; I2 = 18%; 4 trials; 1050 participants; moderate‐certainty evidence; Analysis 1.2). Interventions probably improve blood glucose levels in diabetes (SMD ‐0.81, 95% CI ‐1.60 to ‐0.02; I2 = 96%; 6 trials; 651 participants; moderate‐certainty evidence; Analysis 1.2), though the high level of heterogeneity is important here. Interventions probably made little or no difference for cardiovascular risk (SMD ‐0.08, 95% CI ‐0.40 to 0.24; I2 = 0%; 2 trials, 150 participants; moderate‐certainty evidence; Analysis 1.2). \n\nMost studies (35 of 57) included some level of intermediate clinical outcome. The ones measured most consistently were in asthma (9 studies), diabetes (10 studies) and cardiovascular risk (hypertension (8 studies) and dyslipidaemia (4 studies)). Health‐promotion interventions probably improve intermediate clinical outcomes slightly in pharmacy users (SMD ‐0.43, 95% CI ‐0.65 to ‐0.21; I2 = 90%; 20 trials, 3971 participants; moderate‐certainty evidence).\n","The findings of this review suggest that the community pharmacy is potentially a helpful setting in which to offer behavioural and health‐promotion interventions. There is evidence to suggest that such interventions probably slightly improve pharmacy user health‐related behaviour, intermediate clinical outcomes ‐ particularly for diabetes and hypertension and quality of life.\n\nSuch interventions are likely to be cost‐effective and the effects are seen across a range of clinical conditions and health‐related behaviours. Nevertheless the magnitude of the effects varies between conditions, and more effective interventions might be developed if greater consideration were given to the theoretical basis of the intervention and mechanisms for effecting behaviour change. \n\nIn summary, health‐promotion interventions in the community pharmacy context probably improve pharmacy workers' behaviour and probably have a slight beneficial effect on health‐related behaviour, intermediate clinical outcomes, and quality of life for pharmacy users. "]
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[null,"Rees  K et al. Mediterranean‐style diet for the primary and secondary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD009825. DOI: 10.1002/14651858.CD009825.pub3\nAvailable here.","Healthy adults and adults at high risk of cardiovascular disease (CVD) (for primary prevention). Adults with established CVD (secondary prevention).  ","30 studies were included in the overall review. The results for blood pressure outcomes are reported below. \n\n1. Mediterranean dietary intervention versus no intervention or minimal intervention for primary prevention\n\nTwo trials (269 participants) measured SBP and reported data that could be used in meta‐analyses. There was moderate‐quality evidence of a reduction in SBP with the intervention (MD ‐2.99 mm Hg, 95% CI ‐3.45 to ‐2.53, I² = 0%). \n\nOne trial measured SBP but did not provide data in a useable format for meta‐analyses. Preliminary analysis of an ongoing study reported a change in SBP of 2.6 mm Hg between baseline and follow‐up of six months in 181 patients with metabolic disease following Mediterranean dietary advice, with a difference between the intervention and control group who received no advice of ‐5.1% (p< 0.05). \n\nTwo trials (269 participants) measured DBP and reported data that could be used in meta‐analyses. There was moderate‐quality evidence of a reduction in DBP with the intervention (MD ‐2.0 mm Hg, 95% CI ‐2.29 to ‐1.71, I² = 0%).\n\n \n\n\n","Despite the relatively large number of studies included in this review, there is still some uncertainty regarding the effects of a Mediterranean‐style diet on clinical endpoints and CVD risk factors for both primary and secondary prevention. The quality of evidence for the modest benefits on CVD risk factors in primary prevention is low or moderate, with a small number of studies reporting minimal harms. There is a paucity of evidence for secondary prevention. The ongoing studies may provide more certainty in the future. \n\nAuthors' implications for practice:\nDespite the large number of trials included in the review there is still uncertainty regarding the effects of a Mediterranean‐style diet on clinical endpoints and cardiovascular disease (CVD) risk factors for both primary and secondary prevention from current clinical trial evidence. However, based on supportive observational evidence, positive findings from early clinical trials and the biological plausibility of several mechanisms to explain the beneficial effect of the Mediterranean diet, it has become a popular dietary pattern. \n\nIndeed, some aspects and components of a Mediterranean‐style diet are already included in scientific and clinical guidelines to promote healthy eating and prevent cardiovascular disease, such as the DASH diet, the 2015 Dietary Guidelines for Americans, the Healthy Eating Plate, and the Eatwell guide. \n"]
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[null,null,null,"2. Mediterranean dietary intervention versus another dietary intervention for primary prevention\n\nFour trials (448 participants) measured SBP and provided data that could be pooled in a meta‐analysis. For the PREDIMED trial, blood pressure was analysed in multivariate analyses and these are reported separately below. There was low‐quality evidence that the Mediterranean diet had little or no effect on SBP levels (MD ‐1.5 mm Hg, 95% CI ‐3.92 to 0.92, I² = 16%). \n\nFour trials (448 participants) measured DBP and provided data that could be pooled in a meta‐analysis. For the PREDIMED trial, blood pressure was analysed in multivariate analyses and these are reported separately below. There was low‐quality evidence that the Mediterranean diet had little or no effect on DBP levels (MD ‐0.26 mm Hg, 95% CI ‐2.41 to 1.9, I² = 37%) (Analysis 2.14). \n\nThe PREDIMED study used multivariate adjusted analyses controlling for centre, age, sex, diabetes, baseline blood pressure and antihypertensive drugs. Mean differences in SBP changes (mm Hg) in the two intervention groups versus the control group after a median follow‐up of 3.8 years were 0.39 (‐0.48 to 1.26) for PREDIMED + extra virgin olive oil (EVOO) versus control (p=0.38) and ‐ 0.72 (‐1.58 to 0.13) for PREDIMED + nuts versus control (p= 0.10). Mean differences in DBP changes (mm Hg) in the two intervention groups versus the control group after a median follow‐up of 3.8 years were ‐1.53 (‐2.01 to ‐1.04) for PREDIMED + EVOO versus control (p < 0.001) and ‐0.65 (‐1.15 to ‐0.15) for PREDIMED + nuts versus control (p = 0.01). \n"]
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[null,null,null,"3. Mediterranean dietary intervention versus usual care for secondary prevention\n\nOne trial (556 participants) measured blood pressure (The Lyon Diet Heart Study). There was very low-quality evidence that the Mediterranean diet produced little or no effect on either SBP (MD -2.00 mm Hg, 95% CI -5.29 to 1.29) or DBP (MD -1.00 mm Hg, 95% CI -4.29 to 2.29). "]
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[null,null,null,"4. Mediterranean dietary intervention versus other dietary intervention for secondary prevention\n\nFour studies report blood pressure for this comparison group with data in a useable format for meta‐analyses. Two of the studies have been excluded in sensitivity analyses from all main analyses due to published concerns regarding the reliability of the data. In the remaining two studies, there was very low‐quality evidence of little or no effect of the Mediterranean diet on SBP levels (MD 1.76 mm Hg, 95% CI ‐2.80 to 6.33, I² = 0%) or DBP levels (MD 0.98 mm Hg, 95% CI ‐1.97 to 3.93, I² = 0%). \n\nIn a further study and preliminary analysis of the AUSMED trial the authors report that compared to the low‐fat diet, the MedDiet did not change the blood pressure profile (p > 0.05). The variables were not measured in a later analysis of the full cohort. \n"]
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[null,"Yang  J et al. Acupuncture for hypertension. Cochrane Database of Systematic Reviews 2018, Issue 11. Art. No.: CD008821. DOI: 10.1002/14651858.CD008821.pub2.\nAvailable here. ","Adults with primary hypertension.","Twenty‐two randomised controlled trials (RCTs) (1,744 people) met the inclusion criteria for the review. The RCTs were of variable methodological quality (most at high risk of bias because of lack of blinding). There was no evidence for a sustained BP lowering effect of acupuncture; only one trial investigated a sustained effect and found no BP lowering effect at three and six months after acupuncture. Four sham acupuncture controlled trials provided very low quality evidence that acupuncture had a short‐term (one to 24 hours) effect on SBP (change) ‐3.4 mm Hg (‐6.0 to ‐0.9) and DBP ‐1.9 mm Hg (95% CI ‐3.6 to ‐0.3). Pooled analysis of eight trials comparing acupuncture with angiotensin‐converting enzyme inhibitors and seven trials comparing acupuncture to calcium antagonists suggested that acupuncture lowered short‐term blood pressure (BP) better than the antihypertensive drugs. However, because of the very high risk of bias in these trials, the review authors concluded that this was most likely a reflection of bias and not a true effect. As a result, the authors did not report these results in the 'Summary of findings' table. Safety of acupuncture could not be assessed as only eight trials reported adverse events. ","At present, there is no evidence for the sustained BP lowering effect of acupuncture that is required for the management of chronically elevated BP. The short‐term effects of acupuncture are uncertain due to the very low quality of evidence. The larger effect shown in non‐sham acupuncture controlled trials most likely reflects bias and is not a true effect. Future RCTs must use sham acupuncture controls and assess whether there is a BP lowering effect of acupuncture that lasts at least seven days."]
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[null,"de Barra  M et al.  Pharmacist services for non‐hospitalised patients. Cochrane Database of Systematic Reviews 2018, Issue 9. Art. No.: CD013102. DOI: 10.1002/14651858.CD013102. \nAvailable here.","Individuals who received services from outpatient pharmacists. ","This review aimed to examine the effect of pharmacists' non-dispensing services on non-hospitalised patient outcomes. \n\nWe included 116 trials comprising 111 trials (39,729 participants) comparing pharmacist interventions with usual care and five trials (2122 participants) comparing pharmacist services with services from other healthcare professionals. Of the 116 trials, 76 were included in meta‐analyses. The 40 remaining trials were not included in the meta‐analyses because they each reported unique outcome measures which could not be combined. Most trials targeted chronic conditions and were conducted in a range of settings, mostly community pharmacies and hospital outpatient clinics and were mainly but not exclusively conducted in high‐income countries. Most trials had a low risk of reporting bias and about 25%‐30% were at high risk of bias for performance  detection and attrition. Selection bias was unclear for about half of the included studies. The effect of pharmacist services on blood pressure outcomes are reported below.\n\nPharmacist services targeting patients versus usual care: \n\nPercentage outside blood pressure range:\nEighteen trials (4107 participants) evaluated whether blood pressure fell outside a specified range. These trials used a mixture of systolic and DBP and a variety of target ranges, but SBP was used in the analysis if both were reported. The results indicate that those in the pharmacist groups may be less likely to have blood pressure outside the target range (odds ratio 0.40, 95% CI 0.29 to 0.55, low‐certainty evidence; I2 = 81%). The asymmetric pattern shown in the funnel plot for this meta‐analysis could be an indication of publication bias.\n\nContinuous measures of blood pressure:\nThirty‐one trials (n = 5,939) and 32 trials (n = 6,003) were included in the meta‐analyses of diastolic and SBP, respectively. On average, there was evidence that pharmacist interventions reduced DBP by −3.50 points (95% CI −5.44 to −1.56) and SBP by −5.96 points (95% CI −7.35 to −4.57) compared with usual care. In both analyses, there was evidence of statistical heterogeneity (I2 = 94% and 74%, respectively).\n","The results demonstrate that pharmacist services have varying effects on patient outcomes compared with usual care. We found no studies comparing services delivered by pharmacists with other healthcare professionals that evaluated the impact of the intervention on the six main outcome measures. The results need to be interpreted cautiously because there was major heterogeneity in study populations, types of interventions delivered and reported outcomes. There was considerable heterogeneity within many of the meta‐analyses, as well as considerable variation in the risks of bias."]
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[null,null,null,"Pharmacist services targeting patients versus other healthcare professionals:\n\nPercentage outside blood pressure range:\nThe review authors did not find any studies comparing pharmacists' non-dispensing roles targeting non-hospitalised patients with other healthcare professionals that reported on the percentage outside blood pressure range. \n\nCompared with other healthcare professionals, pharmacist services were not associated with differences in SBP (3 trials, n=1238, MD 1.31, 95% CI -6.22 to 8.84, I2=94%) and DBP (2 trials, n=959, MD -1.36, 95% CI -4.30 to 1.59, I2=86%). "]
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[null,"Laurant  M et al. Nurses as substitutes for doctors in primary care. Cochrane Database of Systematic Reviews 2018, Issue 7. Art. No.: CD001271. DOI: 10.1002/14651858.CD001271.pub3.\nAvailable here. \n\n\n","Nurses working as substitutes for doctors.","This Cochrane review aimed to investigate the impact of nurses working as substitutes for primary care doctors on: patient outcomes, processes of care and utilisation, including volume and cost. \n\nEighteen RCTs were identified which evaluated the impact of nurses working as substitutes for doctors. \n\nStudy findings suggest that care delivered by nurses, compared to care delivered by doctors, probably generates similar or better health outcomes for a broad range of patient conditions (low‐ or moderate‐certainty evidence). The results for blood pressure are described below:\n\nThree trials focusing on patients with cardiovascular disease or diabetes evaluated clinical outcomes. Meta‐analyses for blood pressure levels suggest that, compared to doctor‐led care, nurse‐led primary care probably slightly improves blood pressure outcomes for both SBP (MD ‐3.73, 95% CI ‐6.02 to ‐1.44, moderate‐certainty evidence) and DBP (MD ‐2.54, 95% CI ‐4.57 to ‐0.52, moderate‐certainty evidence). For both outcomes, data show no evidence of statistical heterogeneity (SBP: I2 = 0%, 95% CI 0 to 90; DBP: I2 = 0%). Assessment of moderate‐certainty evidence is due to high risk of bias in one of the included studies. Results did not change considerably under sensitivity analysis.\n","This review shows that for some ongoing and urgent physical complaints and for chronic conditions, trained nurses, such as nurse practitioners, practice nurses, and registered nurses, probably provide equal or possibly even better quality of care compared to primary care doctors, and probably achieve equal or better health outcomes for patients. Nurses probably achieve higher levels of patient satisfaction, compared to primary care doctors. Furthermore, consultation length is probably longer when nurses deliver care and the frequency of attended return visits is probably slightly higher for nurses, compared to doctors. Other utilisation outcomes are probably the same. The effects of nurse‐led care on process of care and the costs of care are uncertain, and we also cannot ascertain what level of nursing education leads to the best outcomes when nurses are substituted for doctors. "]
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[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Cardiovascular disease prevention: Interactive digital interventions for blood pressure self-management. The Community Guide; 2017.\nAvailable here. ","Participants with high blood pressure. ","This report examines interactive digital interventions for blood pressure self-management, leading to a Community Preventative Task Force (CPSTF) recommendation on the subject. The CPSTF finding is based on the results of a published systematic review (McLean G, Band R, Saunderson K, Hanlon P, Murray E, et al. Digital interventions to promote self-management in adults with hypertension: systematic review and meta-analysis. Journal of Hypertension 2016;34(4):600-12) which included seven RCTs of trials examining the impact of digital interventions on systolic and DBP among recruited participants with high blood pressure. The CPSTFs conclusion of sufficient evidence was based on the magnitude of effect estimates, number of studies, and consistency of effects. \n \nA statistically significant effect for digital interventions was found when pooling results for both SBP (MD -3.7 mm Hg [95% CI -5.3 to -2.2]; six studies) and DBP (MD -2.4 mm Hg [95% CI -4.4 to -0.04]; five studies. One included study also examined the proportion of patients achieving or maintaining blood pressure control. At 24 month follow-up, intervention group participants were significantly more likely to have their blood pressure under control (odds ratio 1.52; [95% CI 1.01 to 2.30]).\n","The Community Preventive Services Task Force (CPSTF) recommends interactive digital interventions for patients who have high blood pressure based on sufficient evidence of effectiveness in reducing blood pressure. Evidence was considered sufficient based on studies that demonstrated improvements in patients’ blood pressure measurements over intervention periods of six weeks to 24 months (median six months)."]
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[null,"Ried  K, Fakler  P, Stocks  NP. Effect of cocoa on blood pressure. Cochrane Database of Systematic Reviews 2017, Issue 4. Art. No.: CD008893. DOI: 10.1002/14651858.CD008893.pub3.\nAvailable here.","Adults (no further restrictions)","This Cochrane review aimed to assess the effects on blood pressure of chocolate or cocoa products versus low‐flavanol products or placebo in adults with or without hypertension when consumed for two weeks or longer.\n\nThirty‐five trials (including 40 treatment comparisons) met the inclusion criteria. Of these, 17 trials were added (20 treatment comparisons) to the 18 trials (20 treatment comparisons) in the previous version of this updated review. \n\nTrials provided participants with 30 to 1218 mg of flavanols (mean = 670 mg) in 1.4 to 105 grams of cocoa products per day in the active intervention group. The control group received either a flavanol‐free product (n = 26 treatment comparisons) or a low‐flavanol‐containing cocoa powder (range 6.4 to 88 mg flavanols (mean = 55 mg, 13 treatment comparisons; 259 mg, one trial). \n\nMeta‐analyses of the 40 treatment comparisons involving 1804 mainly healthy participants revealed a small but statistically significant blood pressure‐reducing effect of flavanol‐rich cocoa products compared with control in trials of two to 18 weeks duration (mean nine weeks): Mean difference SBP (95% confidence interval (CI): ‐1.76 (‐3.09 to ‐0.43) mm Hg, p = 0.009, n = 40 treatment comparisons, 1804 participants; Mean difference DBP (95% CI): ‐1.76 (‐2.57 to ‐0.94) mm Hg, p < 0.001, n = 39 treatment comparisons, 1772 participants. \n\nBaseline blood pressure may play a role in the effect of cocoa on blood pressure. While SBP was reduced significantly by 4 mm Hg in hypertensive people (n = 9 treatment comparisons, 401 participants), and tended to be lowered in prehypertensive people (n= 8 treatment comparisons, 340 participants), there was no significant difference in normotensive people (n = 23 treatment comparisons, 1063 participants); however, the test for subgroup differences was of borderline significance (p = 0.08; I2 = 60%), requiring further research to confirm the findings. \n\n\n","This review provides moderate‐quality evidence that flavanol‐rich chocolate and cocoa products cause a small (2 mm Hg) blood pressure‐lowering effect in mainly healthy adults in the short term. \n\nThese findings are limited by the heterogeneity between trials, which could not be explained by prespecified subgroup analyses, including blinding, flavanol content of the control groups, age of participants, or study duration. However, baseline blood pressure may play a role in the effect of cocoa on blood pressure; subgroup analysis of trials with (pre)hypertensive participants revealed a greater blood pressure‐reducing effect of cocoa compared to normotensive participants with borderline significance. \n\nLong‐term trials investigating the effect of cocoa on clinical outcomes are also needed to assess whether cocoa has an effect on cardiovascular events and to assess potential adverse effects associated with chronic ingestion of cocoa products. \n"]
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[null,"Karmali  KN, et al. Risk scoring for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No.: CD006887. DOI: 10.1002/14651858.CD006887.pub4.\nAvailable here.","Adults without CVD.","This Cochrane review aimed to assess the effects of evaluating and providing CVD risk scores in adults, without prevalent CVD, on cardiovascular outcomes, risk factor levels, preventive medication prescribing, and health behaviours. \n\nWe identified 41 RCTs involving 194,035 participants. We assessed studies as having high or unclear risk of bias across multiple domains. Low‐quality evidence suggests that providing CVD risk scores may have little or no effect on CVD events compared with usual care (5.4% versus 5.3%; RR 1.01, 95% confidence interval (CI) 0.95 to 1.08; I² = 25%; 3 trials, n = 99,070). Providing CVD risk scores may reduce CVD risk factor levels by a small amount compared with usual care. Providing CVD risk scores reduced total cholesterol (MD −0.10 mmol/L, 95% CI −0.20 to 0.00; I² = 94%; 12 trials, n = 20,437, low‐quality evidence), SBP (MD −2.77 mm Hg, 95% CI −4.16 to −1.38; I² = 93%; 16 trials, n = 32,954, low‐quality evidence), and multivariable CVD risk (SMD −0.21, 95% CI −0.39 to −0.02; I² = 94%; 9 trials, n = 9549, low‐quality evidence). Providing CVD risk scores may reduce adverse events compared with usual care, but results were imprecise (1.9% versus 2.7%; RR 0.72, 95% CI 0.49 to 1.04; I² = 0%; 4 trials, n = 4630, low‐quality evidence). Compared with usual care, providing CVD risk scores may increase new or intensified lipid‐lowering medications (15.7% versus 10.7%; RR 1.47, 95% CI 1.15 to 1.87; I² = 40%; 11 trials, N = 14,175, low‐quality evidence) and increase new or increased antihypertensive medications (17.2% versus 11.4%; RR 1.51, 95% CI 1.08 to 2.11; I² = 53%; 8 trials, n = 13,255, low‐quality evidence). ","There is uncertainty whether current strategies for providing CVD risk scores affect CVD events. Providing CVD risk scores may slightly reduce CVD risk factor levels and may increase preventive medication prescribing in higher‐risk people without evidence of harm. There were multiple study limitations in the identified studies and substantial heterogeneity in the interventions, outcomes and analyses, so readers should interpret results with caution. New models for implementing and evaluating CVD risk scores in adequately powered studies are needed to define the role of applying CVD risk scores in primary CVD prevention. "]
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[null,"Clar  C et al. Low glycaemic index diets for the prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD004467. DOI: 10.1002/14651858.CD004467.pub3.\nAvailable here. ","Adults who were either healthy, had established cardiovascular disease, or one or more of the following risk factors: abnormal blood lipid levels (high and low density lipoprotein (HDL, LDL) cholesterol, triglycerides and total cholesterol), raised blood pressure/hypertension, overweight (body mass index (BMI) > 25 kg/m2), or obesity (BMI > 30 kg/m2).","This Cochrane review aimed to assess the effect of the dietary glycemic index (GI) on total mortality, cardiovascular events, and cardiovascular risk factors (blood lipids, blood pressure) in healthy people or people who have established cardiovascular disease or related risk factors, using all eligible RCTs.\n\nTwenty‐one RCTs were included, with a total of 2538 participants randomised to low GI intervention (1288) or high GI (1250). All 21 included studies reported the effect of low GI diets on risk factors for cardiovascular disease, including blood lipids and blood pressure. Blood pressure change was a secondary outcome and the results are reported below: \n\nPrimary prevention:\n\nEleven studies reported blood pressure and nine of these could be summarised in a meta‐analysis (10 comparisons). Including all studies reporting this outcome, the change in SBP from baseline to study end varied between ‐10 and +4.5 mm Hg (mean ‐3.44 mm Hg) in the low GI groups and between ‐14 and +5.1 mm Hg (mean ‐4.14 mm Hg) in the control groups. The change in DBP from baseline to study end varied between ‐8 and +1.9 mm Hg (mean ‐1.85 mm Hg) in the low GI groups and between ‐8 and +3.6 mm Hg (mean ‐2.37 mm Hg) in the control groups.\n\nThe pooled analysis showed no evidence of a difference between comparison groups in SBP (MD 0.52 mm Hg, 95% CI ‐1.21 to 2.25, p = 0.55, 786 participants, nine studies, 10 comparisons) with no substantial heterogeneity (I2 = 7%). The pooled analysis showed no evidence of a difference between comparison groups in DBP (MD ‐0.23 mm Hg, 95% CI ‐1.42 to 0.96, p = 0.71, 786 participants, nine studies, 10 comparisons) where there was moderate heterogeneity (I2 = 38%). No evidence of an effect of the magnitude of the difference in GI between comparison diets, of study duration or of weight loss versus weight maintenance studies could be seen.\n\nOf the trials that could not be included in the pooled analysis, the RISCK trial did not show evidence of a difference in systolic or DBP between the low and high GI groups after 24 weeks of intervention. Similarly, there was no evidence of a difference in systolic or DBP between the low and high GI groups after one year in a subgroup of participants of the DiOGenes trial and no evidence of a difference in DBP after four months of intervention in one futher trial.\n\nSecondary Prevention:\n\nIn the one study including participants with CHD, there was no evidence of any differences seen between groups in SBP (MD ‐2.00 mm Hg, 95% CI ‐14.97 to 10.97, 55 participants, one study, one comparison) and DBP (MD ‐4.00 mm Hg, 95% CI ‐13.41 to 5.41).\n\n","There is currently no evidence available regarding the effect of low GI diets on cardiovascular disease events. Moreover, there is currently no convincing evidence that low GI diets have a clear beneficial effect on blood lipids or blood pressure parameters."]
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[null,"Kelly SAM et al. Whole grain cereals for the primary or secondary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2017, Issue 8. Art. No.: CD005051. DOI: 10.1002/14651858.CD005051.pub3.\nAvailable here.","Healthy adults, those at increased risk of CVD, or those who have been previously diagnosed with CVD. ","The aim of this systematic review was to assess the effect of whole grain foods or diets on total mortality, cardiovascular events, and cardiovascular risk factors (blood lipids, blood pressure) in healthy people or people who have established cardiovascular disease or related risk factors, using all eligible RCTs.\n\nNine RCTs randomising a total of 1414 participants (age range 24 to 70; mean age 45 to 59, where reported) to whole grain versus lower whole grain or refined grain control groups were included. Blood pressure change was a secondary outcome in this review and the results are reported below:\n\nEight studies reported SBP and data from seven studies (eight comparators) could be summarised in a meta‐analysis. The pooled analysis showed no effect on SBP (MD 0.04, 95% CI ‐1.67 to 1.75; 768 participants). There was no substantial heterogeneity. In the study that could not be included in the meta‐analysis, there were no effects of whole grain foods compared with the control group. \n\nEight studies reported DBP, and data from seven studies (eight comparators) could be summarised in a meta‐analysis. The pooled analysis showed no effect on DBP (MD 0.16, 95% CI ‐0.89 to 1.21; 768 participants). There was no heterogeneity. In the study that could not be included in the meta‐analysis, there were no effects of whole grain foods compared with the control group. \n\n\n\n","There is insufficient evidence from RCTs of an effect of whole grain diets on cardiovascular outcomes or on major CVD risk factors such as blood lipids and blood pressure. Trials were at unclear or high risk of bias with small sample sizes and relatively short‐term interventions, and the overall quality of the evidence was low. There is a need for well‐designed, adequately powered RCTs with longer durations assessing cardiovascular events as well as cardiovascular risk factors. "]
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[null,"Al‐Khudairy L et al.  Vitamin C supplementation for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No.: CD011114. DOI: 10.1002/14651858.CD011114.pub2\nAvailable here. ","Healthy adults (18 years old or over) from the general population and those at moderate to high risk of CVD (e.g. hypertension, hyperlipidaemia, overweight/obesity).","The aim of this Cochrane review was to determine the effectiveness of vitamin C supplementation as a single supplement for the primary prevention of CVD. \n\nEight trials were included with 15,445 participants randomised. The largest trial with 14,641 participants provided data on the primary outcomes. Seven trials reported on CVD risk factors. Three of the eight trials were regarded at high risk of bias for either reporting or attrition bias, most of the 'Risk of bias' domains for the remaining trials were judged as unclear, with the exception of the largest trial where most domains were judged to be at low risk of bias. Blood pressure was a secondary outcome of the review and the results are reported below:\n\nOne trial reported data that could be used in a meta‐analysis. This trial reported no effects of vitamin C supplementation on either SBP (mean difference (MD) ‐1.00 mm Hg, 95% CI ‐4.94 to 2.94; 16 participants) or DBP (MD ‐2.00 mm Hg, 95% CI ‐6.82 to 2.82; 16 participants). However, this study was extremely small, at high risk of attrition bias so results should be treated with caution. Antihypertensive medication was also used by some participants, which may have impacted on the results obtained. \n\nNo control group data were provided for one trial so these were not usable in a meta‐analysis. \n\nOne cross‐over trial reported results over the whole trial period and not in phases so the results could not be incorporated in the meta‐analysis. The review authors reported that clinic blood pressure did not change between the placebo and vitamin C stages. Daytime ambulatory blood pressure showed a smaller decrease in SBP of 2 ± 5.2 mm Hg in comparison to DBP 1 ± 4.7 mm Hg for 40 participants. \n\nFor one study, blood pressure was reported at baseline but not at follow‐up (ASAP Study). \n\n\n","Currently, there is no evidence to suggest that vitamin C supplementation reduces the risk of CVD in healthy participants and those at increased risk of CVD, but current evidence is limited to one trial of middle‐aged and older male physicians from the USA. There is limited low‐ and very low‐quality evidence currently on the effect of vitamin C supplementation and risk of CVD risk factors. "]
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[null,"Smith SM et al. Shared care across the interface between primary and specialty care in management of long term conditions. Cochrane Database of Systematic Reviews 2017, Issue 2. Art. No.: CD004910. DOI: 10.1002/14651858.CD004910.pub3.\nAvailable here.","People or populations with a specific chronic disease (e.g. hypertension), primary care physicians and specialist care physicians. ","This Cochrane review aimed to determine the effectiveness of shared care health service interventions designed to improve the management of chronic disease across the primary/specialty care interface. This is an update of a previously published review. \n\nThe authors identified 42 studies of shared care interventions for chronic disease management (n = 18,859), 39 of which were RCTs, two CBAs and one an NRCT. Of these 42 studies, 41 examined complex multi‐faceted interventions and lasted from six to 24 months. Overall, review authors confidence in results regarding the effectiveness of interventions ranged from moderate to high certainty. Results showed probably few or no differences in clinical outcomes overall with a tendency towards improved blood pressure management in the small number of studies on shared care for hypertension, chronic kidney disease and stroke (mean difference (MD) 3.47, 95% confidence interval (CI) 1.68 to 5.25)(based on moderate‐certainty evidence). \n\n","This review suggests that shared care improves depression outcomes and probably has mixed or limited effects on other outcomes. Methodological shortcomings, particularly inadequate length of follow‐up, may account in part for these limited effects.  Shared care interventions for conditions other than depression should be developed within research settings, with account taken of the complexity of such interventions and awareness of the need to carry out longer studies to test effectiveness and sustainability over time. "]
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[null,"Brown TJ, Todd A, O'Malley CL, Moore HJ, Husband AK, Bambra C, et al. Community pharmacy interventions for public health priorities: a systematic review of community pharmacy-delivered smoking, alcohol and weight management interventions. Public Health Research 2016;4(2)\nAvailable here","Adults, including some studies focused on adults with the comorbidity of high blood pressure.","The review included five weight loss and five multicomponent interventions that included pharmacotherapy and lifestyle changes in participants with diabetes mellitus, dyslipidaemia or hypertension.\nNine of the studies were UK based; seven of the studies were rated ‘strong’ for quality. All studies were of adults.\nEvidence suggests that pharmacy-based weight-loss interventions are as effective as similar interventions in other primary care settings, but not as effective or cost-effective as commercially provided weight management services based in community settings. \nNone of the five multicomponent studies demonstrated an improvement compared with control for anthropometric outcomes in participants with comorbidities, but they did show improvement in measures associated with the comorbidities. The evidence suggests that a distinct group of people might access pharmacies compared with other settings for weight loss. \nThere is insufficient evidence to examine the relationship between behaviour change strategies and effectiveness; or evidence of consistent implementation factors or training components that underpin effective interventions.","Pharmacy-based weight loss interventions appear to be\nas effective as similar interventions in other primary care settings, but not as effective or cost-effective as\ncommercially provided weight management services in community settings. No study assessed the\ndifferential effects of any measure of SES; therefore, the impact of any of the interventions on health\ninequalities is unknown.\nEvaluations of interventions to manage alcohol misuse and obesity, set within the community pharmacy, are needed. The effect of community pharmacy interventions on health inequalities is unclear. Future research in this area is warranted, and trials should include the assessment of age, sex, ethnicity, socioeconomic status and contextual factors, and present analysis of how these factors moderate effectiveness."]
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[null,"Weiss J et al. Benefits and Harms of Treating Blood Pressure in Older Adults: A Systematic Review and Meta-analysis. Portland: Department of Veterans Affairs, evidence based synthesis program; 2016.\nAvailable here.","Adults ≥ 60 years with a diagnosis of hypertension at the time of enrolment","This review from the Department of Veterans Affairs evidence based synthesis programme aimed to examine the benefits and harms of differing blood pressure targets among adults aged over 60. \n\nTwenty-one RCTs and three cohort studies were included in the review. Overall, the review found high strength of evidence that treating blood pressure in patients over age 60 to current treatment targets (<150/90 mm Hg) substantially reduces mortality, stroke and cardiac events. Most of the data came from trials in which the mean baseline SBP was 160 mm Hg. The review authors found evidence driven mainly by one large trial, that lower targets (SBP < 140 mm Hg or DBP < 85 mm Hg) compared to higher targets reduced stroke (moderate strength evidence) and cardiac events (low strength evidence); mortality was also reduced though not significantly (low strength evidence). There is little data that directly helps distinguish benefits between SBP 140 and 150 mm Hg. Most of the trials achieving SBP < 140 mm Hg were the treat-to-target trials. Only one trial included patients with baseline SBP 140-150 mm Hg and found an improvement in mortality, but not other outcome. The authors found moderate strength evidence that more aggressive blood pressure control (SBP < 140 mm Hg) in patients with prior stroke substantially reduced rates of recurrent stroke.","Lowering blood pressure in adults over age 60 reduces mortality, stroke, and cardiac events. The most consistent and largest effects are seen in studies of patients with higher baseline blood pressures (SBP ≥ 160 mm Hg) achieving moderate blood pressure control (< 150/90 mm Hg). Lower treatment targets (< 140/85 mm Hg) are likely to be beneficial for some patients at high cardiovascular risk, but the results across trials are less consistent. Lower treatment targets are largely supported by findings from one trial which targeted SBP <120 mm Hg and in which most intervention patients achieved SBP < 130 mm Hg. In patients with cerebrovascular disease, more aggressive blood pressure lowering (SBP <140 mm Hg) likely reduces recurrent stroke. Lower treatment targets are associated with higher medication burden and an increased risk of short-term harms such as hypotension. On the other hand, evidence that there is not an increased risk in cognitive impairment, falls and reduced quality of life may provide some flexibility for providers in crafting an individualised antihypertensive treatment plan. There is little data to assess the risks and benefits of antihypertensive treatment among institutionalised elder patients or those with multiple comorbidities"]
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[null,"Brunton G et al. Developing evidence-informed, employer-led workplace health. London: EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London; 2016. Available here.","Male NHS employees","One included study (Lomas and McCluskey, 2005) aimed to evaluate the effectiveness of a workplace health promotion initiative. Blood screening was taken into the workplace setting for all staff members who wished to take part.\n\nThis study examined the perceptions of male NHS workers across a range of worksites who took part in a blood pressure screening intervention. The authors were interested in men’s perceptions of the experience and the impact of screening on men’s health decision-making processes, and they aimed to identify ways to improve the intervention. Semi-structured interviews were conducted with workers and managers, and thematic analysis undertaken. The overall usefulness rating for this study was high. The sample covered a broad range of work roles in the NHS, and the intervention, which was specifically targeted towards men, resulted in a successful outcome. By offering blood pressure screening on site, the male participants were more likely to take an interest in their own health. Other factors which encouraged participation were the professionalism of the deliverer, the effort made with regard to the welfare of the recruits, and external and internal support.","The overall review (synthesis of views studies (n=10) and policy report (n=14) suggests that 'managerial support’ is a key mechanism for the successful implementation of workplace health. Characteristics relate to all levels of managerial roles/responsibilities and are applicable to companies of different sizes and scales. Key points have been highlighted:\n- Managers could encourage staff to participate in workplace health, e.g. web-based health programmes, blood pressure screenings, weight management or mental health\ninitiatives, or could support employees’ career progression.\n- Managers could provide ongoing support and ‘follow up’: follow up, such as reminders and communication about workplace health, is perceived as leading to ongoing commitment from staff."]
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[null,"Ho J, Li E, Wright J. Blood pressure lowering efficacy of coenzyme Q10 for primary hypertension. Cochrane Database of Systematic Reviews 2016, Issue 3. Art. No.: CD007435. DOI: 10.1002/14651858.CD007435.pub3.\nAvailable here. ","Patients with primary hypertension.","This cochrane review update aimed to determine the blood pressure lowering effect of coenzyme Q10 in primary hypertension. \n\nIn this update of the review, one new randomised, controlled cross‐over trial with a total of 30 participants was added, and one trial included in the initial review was excluded. Only two of the three included trials were pooled in the meta‐analysis, as one trial was judged to have an unacceptably high risk of bias. In the meta‐analysis of two RCTs (50 participants), coenzyme Q10 did not significantly change systolic BP: ‐3.68 mm Hg (95% confidence interval (CI) ‐8.86 to 1.49), or diastolic BP: ‐2.03 mm Hg (95% CI ‐4.86 to 0.81] ), based on clinic data. ","This review provides moderate‐quality evidence that coenzyme Q10 does not have a clinically significant effect on blood pressure. In one of three trials reporting adverse effects, coenzyme Q10 was well tolerated. Due to the small number of individuals and studies available for analysis, more well‐conducted trials are needed. "]
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[null,"Semlitsch  T et al. Long‐term effects of weight‐reducing diets in people with hypertension. Cochrane Database of Systematic Reviews 2016, Issue 3. Art. No.: CD008274. DOI: 10.1002/14651858.CD008274.pub3.\nAvailable here. ","Adults with primary hypertension. ","This Cochrane review update aimed to assess the long-term effects of weight-reducing diets in people with hypertension on change from baseline in SBP, change from baseline in DBP and body weight reduction. \n\nThe update did not reveal any new studies, so the number of included studies remained the same: eight studies involving a total of 2100 participants with high blood pressure and a mean age of 45 to 66 years. Mean treatment duration was six to 36 months. Risk of bias was judged as unclear or high for all but two trials. No study included mortality as a predefined outcome. \n\nThere was low‐quality evidence for a blood pressure reduction in participants assigned to weight loss diets as compared to controls: SBP: mean difference (MD) ‐4.5 mm Hg (95% CI ‐7.2 to ‐1.8 mm Hg) (n=3 studies), and DBP: MD ‐3.2 mm Hg (95% CI ‐4.8 to ‐1.5 mm Hg) (n=3 studies). There was moderate‐quality evidence for weight reduction in dietary weight loss groups as compared to controls: MD ‐4.0 kg (95% CI ‐4.8 to ‐3.2) (n=5 studies). ","In this update, the conclusions remain the same, as we found no new trials. In people with primary hypertension, weight loss diets reduced body weight and blood pressure, however the magnitude of the effects are uncertain due to the small number of participants and studies included in the analyses. Whether weight loss reduces mortality and morbidity is unknown. No useful information on adverse effects was reported in the relevant trials. "]
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[null,"Posadzki  P et al. Automated telephone communication systems for preventive healthcare and management of long‐term conditions. Cochrane Database of Systematic Reviews 2016, Issue 12. Art. No.: CD009921. DOI: 10.1002/14651858.CD009921.pub2.\nAvailable here. ","Consumers (including carers) who received automated telephone communication systems (ATCS) interventions for prevention or management of long-term conditions, regardless of age, sex, education, marital status, employment status or income. ATCS deliver voice messages and collect information from consumers. ","This Cochrane review aimed to assess the effects of ATCS on behavioural change, clinical, process, cognitive, patient-centred and adverse outcomes, for preventing disease and managing long-term conditions. \n\nThere are four different types of ATCS: unidirectional (one-way, non-interactive voice communication), interactive voice response (IVR) systems, ATCS with additional functions such as access to an expert to request advice (ATCS Plus) and multimodal ATCS, where the calls are delivered as part of a multicomponent intervention.\n\nOne hundred and thirty two trials (n = 4,699,689) were included in the whole review and studies spanned several clinical areas, assessing many comparisons based on evaluation of different ATCS types and variable comparison groups. The results for ATCS versus usual care for management of hypertension are reported below:\n\nFive studies evaluated ATCS for managing hypertension; one took place in Honduras/Mexico, and four were in the USA. Sample size ranged from 166 to 64,773 participants. Mean age ranged from 58 years to 66 years. Participants in three studies were also diagnosed with diabetes mellitus. All studies monitored blood pressure as a primary outcome. \n\nMeta‐analysis of three trials, found that ATCS slightly reduced SBP compared with usual care with or without information (MD −1.89 mm Hg, 95% −2.12 to −1.66; moderate certainty evidence). There was no evidence of heterogeneity among the pooled studies (Tau2 = 0.00; Chi2 = 1.48, df = 2 (P = 0.48); I2 = 0%). \n\nMeta‐analysis of two trials reported no effect for ATCS on DBP compared with usual care (MD 0.02 mm Hg, 95% CI −2.62 to 2.66; low certainty evidence). There was a substantial degree of heterogeneity in the meta‐analysed studies (Tau2 = 2.84; Chi2 = 3.63, df = 1 (p = 0.06); I2 = 72%). \n\nTwo studies were not included in the meta-analysis as they reported different outcomes or insufficient information to allow inclusion. One study found that compared with usual care, a multimodal/complex intervention (ATCS Plus plus sphygmomanometer, a weighting scale, pedometer, and instructions on their use) probably had little or no effect on blood pressure control at six months (54.5% controlled in intervention group versus 52.3% in usual care group, p = 0.43; moderate certainty evidence). \n\nOne study reported that compared with usual care plus education, IVR may have had little or no effect on SBP at three months (p > 0.05; low certainty evidence). \n\n\n","ATCS interventions can change patients' health behaviours, improve clinical outcomes and increase healthcare uptake with positive effects in several important areas including immunisation, screening, appointment attendance, and adherence to medications or tests. The decision to integrate ATCS interventions in routine healthcare delivery should reflect variations in the certainty of the evidence available and the size of effects across different conditions, together with the varied nature of ATCS interventions assessed. Future research should investigate both the content of ATCS interventions and the mode of delivery; users' experiences, particularly with regard to acceptability; and clarify which ATCS types are most effective and cost‐effective. "]
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[null,"Hartley  L et al. Dietary fibre for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2016, Issue 1. Art. No.: CD011472. DOI: 10.1002/14651858.CD011472.pub2.\nAvailable here. ","Adults at risk of CVD or those from the general population","This Cochrane review aimed to determine the effectiveness of dietary fibre for the primary prevention of CVD. \n\nTwenty-three RCTs (1513 participants randomised) were included in the full review.  The risk of bias was unclear for most studies and studies had small sample sizes. Few studies had an intervention duration of longer than 12 weeks. There was a wide variety of fibre sources used, with little similarity between groups in the choice of intervention.  Change in blood pressure was a secondary outcome of the review, the results are reported below:\n\nEight studies reported SBP and could be summarised in a meta‐analysis (10 comparisons). The pooled analysis showed a reduction in SBP with the intervention but this did not reach statistical significance (MD ‐1.92 mm Hg, 95% CI ‐4.02 to 0.19; p = 0.07). There was significant heterogeneity (p = 0.0006; I2 = 69%) and results were pooled with a random‐effects model. \n\nEight studies reported DBP and could be summarised in a meta‐analysis (10 comparisons). The pooled analysis showed a significant difference between comparison groups favouring fibre (MD ‐1.77 mm Hg, 95% CI ‐2.61 to ‐0.92; p < 0.0001). There was no significant heterogeneity (P = 0.37; I2 = 7%). ","Studies were short term and therefore did not report on the primary outcomes for the review, CVD clinical events. The pooled analyses for CVD risk factors suggest reductions in total cholesterol and LDL cholesterol with increased fibre intake, and reductions in DBP. There authors found no obvious effects of subgroup analyses by type of intervention or fibre type but the number of studies included in each of these analyses were small. Risk of bias was unclear in the majority of studies and high for some quality domains so results need to be interpreted cautiously. The review authors state that there is a need for longer term, well‐conducted RCTs to determine the effects of fibre type (soluble versus insoluble) and administration (supplements versus foods) on CVD events and risk factors for the primary prevention of CVD. "]
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[null,"Dyakova  M et al.  Systematic versus opportunistic risk assessment for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2016, Issue 1. Art. No.: CD010411. DOI: 10.1002/14651858.CD010411.pub2.\nAvailable here. ","Healthy adults from the general population including those who are at risk of CVD.","This Cochrane review aimed to assess the effectiveness, costs and adverse effects of systematic risk assessment compared to opportunistic risk assessment for the primary prevention of CVD. \n\nNine completed RCTs met the inclusion criteria for the review, of which four were cluster‐randomised. The authors also identified five ongoing trials. The included studies had a high or unclear risk of bias, and the GRADE ratings of overall quality were low or very low. Blood pressure change was a secondary outcome for the review, the results are reported below: \n\nSix studies reported SBP at follow‐up and were combined in a meta‐analysis. Mean SBP was lower in the intervention group compared with the control group (MD ‐3.05 mm Hg, 95% CI ‐4.84 to ‐1.25; participants = 12,591; studies = 6; I² = 82%; very low‐quality evidence). There was considerable statistical heterogeneity, so review auhtors combined the data with a random‐effects model. Sensitivity analysis suggested that BFHS 1994 had a considerable impact on the results. Removing this study from the analysis reduced statistical heterogeneity to 0% and reduced uncertainty, as demonstrated by a narrower confidence interval. The mean difference, although slightly less, remained statistically significant (MD ‐1.91 mm Hg, 95% CI ‐2.67 to ‐1.16; participants = 10,584; studies = 5; I² = 0%). \n\nSix studies reported DBP at follow‐up and were combined in a meta‐analysis. Mean DBP was lower in the intervention group compared with the control group (MD ‐1.34 mm Hg, 95% CI ‐1.76 to ‐0.93; participants = 12,591; studies = 6; I² = 0%; low‐quality evidence). ","The results are limited by the heterogeneity between trials in terms of participants recruited, interventions and duration of follow‐up. Limited data suggest that systematic risk assessment for CVD has no statistically significant effects on clinical endpoints. There is limited evidence to suggest that CVD systematic risk assessment may have some favourable effects on cardiovascular risk factors. The completion of the five ongoing trials will add to the evidence base. "]
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[null,"Weeks  G et al. Non‐medical prescribing versus medical prescribing for acute and chronic disease management in primary and secondary care. Cochrane Database of Systematic Reviews 2016, Issue 11. Art. No.: CD011227. DOI: 10.1002/14651858.CD011227.pub2.\nAvailable here. ","Healthcare providers who are not medical doctors, undertaking prescribing including, nurses, optometrists, pharmacists, physician assistants, and other allied health professionals or categories not specifically mentioned whose roles meet the authors definition of non‐medical prescribing","This Cochrane review aimed to assess clinical, patient-reported and resource use outcomes of non-medical prescribing for managing acute and chronic health conditions in primary and secondary care settings compared with medical prescribing (usual care). \n\nForty-six studies were included in the review (37,337 participants); non‐medical prescribing was undertaken by nurses in 26 studies and pharmacists in 20 studies. In 45 studies non‐medical prescribing as a component of care was compared with usual care medical prescribing. A further study compared nurse prescribing supported by guidelines with usual nurse prescribing care. No studies were found with non‐medical prescribing being undertaken by other health professionals. The education requirement for non‐medical prescribing varied with country and location. \n\nNon-medical prescribing in chronic care (primary/ambulatory care):\n\nEleven ambulatory care studies (2076 participants) reporting SBP at six months showed a mean difference (MD) favouring the non‐medical prescribing group compared to usual care of ‐6.76 mm Hg (95% CI ‐8.24 to ‐5.27;), but there was considerable heterogeneity (I2 = 82%, overall effect p < 0.00001). At 12 months, 12 ambulatory care studies (4229 participants) showed a MD favouring the non‐medical prescribing group of ‐5.31 mm Hg (95% CI ‐6.46 to ‐4.16) with moderate heterogeneity (I2 = 50%, overall effect p < 0.00001). The test for subgroup differences was not significant (I2 = 56.3%, p= 0.13). \n\nThe SBP effect estimate at six months for the fixed‐effect model was MD ‐6.76 mm Hg, 95% CI ‐8.24 to ‐5.27 compared to the random‐effects estimate (MD ‐7.34 mm Hg, 95% CI ‐11.09 to ‐3.60). At 12 months the respective comparison was MD ‐5.31 mm Hg, 95% CI ‐6.46 to ‐4.16 versus MD ‐5.91 mm Hg, 95% CI ‐7.71 to ‐4.10. There was a moderate‐certainty of evidence.\n\nExcluding the cluster‐RCT at six months, the effect estimate was MD ‐6.13 mm Hg, 95% CI ‐7.83 to ‐4.44; 10 studies, 1628 participants. Excluding the cluster‐RCTs at 12 months, the effect estimate was MD ‐4.84 mm Hg, 95% CI ‐6.29 to ‐3.39; 10 studies, 2627 participants. \n\nThe subgroup analysis of four studies (695 participants) where non‐medical prescribers demonstrated a higher level of prescribing autonomy in the control of SBP showed: fixed‐effect MD ‐2.98 mm Hg, 95% CI ‐5.36 to ‐0.59; p = 0.01, compared with a random‐effects model MD ‐6.78 mm Hg, 95% CI ‐15.38 to 1.81; p = 0.12, with considerable heterogeneity I2 = 90%. \n\n\n\n","The findings suggest that non‐medical prescribers, practising with varying but high levels of prescribing autonomy, in a range of settings, were as effective as usual care medical prescribers. Non‐medical prescribers can deliver comparable outcomes for SBP, glycated haemoglobin, low‐density lipoprotein, medication adherence, patient satisfaction and health‐related quality of life. It was difficult to determine the impact of non‐medical prescribing compared to medical prescribing for adverse events and resource use outcomes due to the inconsistency and variability in reporting across studies. Future efforts should be directed towards more rigorous studies that can clearly identify the clinical, patient‐reported, resource use, and economic outcomes of non‐medical prescribing, in both high‐income and low‐income countries. "]
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[null,"McLaren  L et al. Population‐level interventions in government jurisdictions for dietary sodium reduction. Cochrane Database of Systematic Reviews 2016, Issue 9. Art. No.: CD010166. DOI: 10.1002/14651858.CD010166.pub2\nAvailable here. ","Populations of all ages.","This Cochrane review aimed to assess the impact of population-level interventions for dietary sodium reduction in government jurisdictions worldwide and to assess the differential impact of those initiatives by social and economic indicators. \n\nFifteen national initiatives which included more than 260,000 people met the inclusion criteria for the review. None of the initiatives were in lower middle income or low income countries and all except one used an uncontrolled pre-post study design. \n\nTen initiatives provided sufficient data for quantitative analysis of impact (64,798 participants). Evidence was graded as very low due to the risk of bias of the included studies, as well as variation in the direction and size of effect across the studies. Five of these showed mean decreases in average daily salt intake per person from pre‐intervention to post‐intervention, ranging from 1.15 grams/day less (Finland) to 0.35 grams/day less (Ireland). Two initiatives showed mean increase in salt intake from pre‐intervention to post‐intervention: Canada (1.66) and Switzerland (0.80 grams/day more per person); however in both countries the pre‐intervention data point was from several years prior to the initiation of the intervention. The remaining initiatives did not show a statistically significant mean change. \n\nSeven of the 10 initiatives were multi‐component and incorporated intervention activities of a structural nature (e.g. food product reformulation, food procurement policy in specific settings). Of those seven initiatives, four showed a statistically significant mean decrease in salt intake from pre‐intervention to post‐intervention, ranging from Finland to Ireland (see above), and one showed a statistically significant mean increase in salt intake from pre‐intervention to post‐intervention (Switzerland; see above). \n\nMany studies had methodological strengths, including large, nationally representative samples of the population and rigorous measurement of dietary sodium intake. However, all studies were scored as having high risk of bias, reflecting the observational nature of the research and the use of an uncontrolled study design. The quality of evidence for the main outcome was low. \n\n\n\n\n","Population‐level interventions in government jurisdictions for dietary sodium reduction have the potential to result in population‐wide reductions in salt intake from pre‐intervention to post‐intervention, particularly if they are multi‐component (more than one intervention activity) and incorporate intervention activities of a structural nature (e.g. food product reformulation) and particularly amongst men. Heterogeneity across studies was significant, reflecting different contexts (population and setting) and initiative characteristics. Implementation of future initiatives should embed more effective means of evaluation to help us better understand the variation in the effects. "]
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[null,"Canadian Agency for Drugs and Technologies in Health. Telehealth for patients with Hypertension, Coronary Artery Disease or Implantable Cardiac Devices: A Review of the Clinical Effectiveness, Cost-effectiveness and Guidelines. Rapid response report: summary with critical appraisal. CADTH; 2016. \nAvailable here. ","Patients with hypertension, CAD and implantable cardiac devices requiring cardiac care. ","This rapid response report aims to review the clinical- and cost-effectiveness of telehealth for patients with hypertension, coronary artery disease (CAD) or conditions requiring implantable cardiac devices.\n\nA total of twelve studies on telehealth for hypertension (four studies), CAD (two studies) and implantable cardiac devices (six studies) were included in the review. Five studies were systematic reviews on clinical effectiveness of telemonitoring, six were cost-effectiveness studies and one was a guideline. \n\nClinical evidence of telehealth for patients with hypertension: \n\nOne systematic review which evaluated the clinical effectiveness of home blood pressure telemonitoring (HBPT) was identified. The systematic review/meta-analysis included 23 RCTs that evaluated the clinical effectiveness of home blood pressure telemonitoring (HBPT), compared to usual care, in adult patients with hypertension, with mean SBP of 144.9 ± 11.4 (SD), and mean DBP of 84.5 ± 5.7 (SD). HBPT was found to improve SBP and DBP, with a difference of 4.71 mm Hg and 2.45 mm Hg, respectively, compared to usual care. The differences were statistically significant. HBPT also increased the chances for patients to achieve office BP normalisation in both diabetic and non-diabetic populations by 16% (relative risk [RR] 1.16; p < 0.001). HBPT helped improve the physical component of quality of life (SF-12 or SF-36 questionnaire: weighted mean difference [WMD] +2.78; 95% confidence interval [CI] +1.15 to +4.41; p < 0.001). There was no statistically significant difference in both intervention and usual care groups in terms of therapeutic adherence, rate of office consultations, and risk of adverse events.\n\n\n","Telemonitoring of blood pressure costs more than usual care, but it may represent a useful tool for hypertension control by improving blood pressure and increasing the chances for patients to achieve blood pressure normalisation. There was no evidence available on the cost-effectiveness of telemonitoring in patients with CAD requiring cardiac rehabilitation, but telehealth interventions do not have inferior outcomes compared to centre-based supervised programs, and telephone support may reduce hospitalisations and reduce risk factors for heart disease. For patients with heart diseases requiring implantable cardiac devices, the costs of telemonitoring were lower than conventional hospital monitoring. Pacemaker telemonitoring led to earlier cardiovascular event detection, with a reduction in hospital visits and hospitalisations. Telemonitoring of implantable cardioverter-defibrillators had similar outcomes compared to in-office follow-up."]
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[null,"Campbell F, Holmes M, Everson-Hock E, Davis S, Buckley Woods H, Anokye N, et al. A systematic review and economic evaluation of exercise referral schemes in primary care: A short report. Health Technology Assessment 2015;19(60)\nAvailable here\n\nReport based on:\nPavey T, Anokye N, Taylor A, Trueman P, Moxham T. The clinical effectiveness and cost-effectiveness of exercise referral schemes: a systematic review and economic \nevaluation.  Health Technology Assessment 2011;15(44)\nAvailable here\n\n","Adults","This report is based on the 2011 systematic review by Pavey et al.\n\nThe proportion of individuals achieving 90–150 minutes of at least moderate-intensity activity per week at 6–12 months’ follow-up was greater for ERSs than usual care (relative risk 1.12; 95% confidence interval 1.04 to 1.20). \nOlder patients and those referred for CHD risk factors appeared to be more likely than others to increase their levels of physical activity. Qualitative evidence suggests that interventions enabling the development of social support networks are beneficial in promoting uptake and adherence. \nReferral to an ERS did not lead to changes in objective measures of health such as weight or blood pressure.","Exercise referral schemes result in a small improvement in the number of people who increase their levels of physical activity. \nThe cost-effectiveness analysis indicates that the ICER for ERSs compared with usual care is around £76,000 per QALY, although the cost-effectiveness of ERSs is subject to considerable uncertainty.\nThere was no evidence that\nthe interventions lead to positive changes in body fat, BMI or blood pressure."]
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[null,"Bloomfield HE et al. Benefits and Harms of the Mediterranean Diet Compared to Other Diets. Minneapolis: Veterans Affairs Evidence-based synthesis program; 2015. \nAvailable here. ","Adults (18+) not pregnant or lactating and not hospitalised or institutionalised. ","This systematic review aimed to assess whether the Mediterranean diet is more effective than other diets in preventing death or the development of type 2 diabetes mellitus, cardiovascular disease, cancer, hypertension, cognitive impairment, or kidney disease. \n\nThe review included 93 papers reporting on 55 studies published between 1990 and 2015. The authors did not find any studies reporting on the Mediterranean diet for preventing or treating hypertension. ","In this systematic review and meta-analysis of 55 published studies we identified a single primary prevention trial which found that consumption of a Mediterranean diet was associated with a significant reduction in major cardiac events, new onset T2DM, and breast cancer incidence. For secondary prevention, data from two trials indicate that assignment to a Mediterranean diet reduces incidence of myocardial infarction but not other cardiovascular outcomes. Cohort studies indicate that conformity to a Mediterranean diet pattern is associated with significant reduction in total cancer incidence, total cancer mortality and colorectal cancer incidence. These associations have not been confirmed in RCTs.  The available data on dietary adherence suggest that sustained increases in consumption of fruits and vegetables and grains can be achieved with labour-intensive behavioral interventions in select populations."]
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[null,"Community Preventive Services Task Force. Cardiovascular Disease Prevention and Control: Self-Measured Blood Pressure Monitoring Interventions for Improved Blood Pressure Control. Task Force Findings and Rationale Statement; 2015.\nAvailable here.\n\nLast updated June 2016. ","Unspecified.","This Community Preventive Service Task Force finding is based on evidence from a systematic review published in 2013 which evaluated the effectiveness of self-measured blood pressure monitoring interventions when used alone or when combined with additional support to manage high blood pressure. For studies evaluating self-measured blood pressure monitoring alone, a meta-analysis was conducted and reported relative risks and weighted net differences across multiple time points. Because of clinical heterogeneity, however, only narrative results were reported for self-measured blood pressure monitoring combined with additional support. To better inform Task Force conclusions on health impact estimates were transformed into absolute percentage point changes and net differences using the latest time point available.\n\nThe finding of sufficient evidence of effectiveness for self-measured blood pressure monitoring interventions when implemented alone is based on evidence from 26 studies with 28 study arms. Patients in these studies received blood pressure monitoring devices, were trained to use them and shared blood pressure readings with their healthcare providers. Results demonstrated consistent and meaningful improvements in blood pressure when the intervention was compared with usual care. Results were statistically significant at the six month time point and continued to be favourable at 12 months, although smaller in magnitude.\n\nThe finding of strong evidence of effectiveness for self-measured blood pressure monitoring interventions when combined with additional support is based on evidence from 25 studies with 29 study arms. Additional support varied between studies and was categorized into three main groups: one-on-one patient counselling or telecounseling (11 studies), access to electronic or web-based tools (seven studies), and education on high blood pressure and blood pressure self-management (five studies). Half of these studies were conducted using a team-based care arrangement where health care providers worked alongside other professionals, such as nurses and pharmacists, to improve coordination of care and support for patients (14 studies with 17 study arms). Results demonstrated consistent and meaningful improvements in blood pressure that were sustained at 12 months when the intervention was compared with usual care.\n\n","The Community Preventive Services Task Force recommends self-measured blood pressure monitoring interventions to improve blood pressure outcomes in patients with high blood pressure. There is sufficient evidence of effectiveness for self-measured blood pressure monitoring interventions when used alone (i.e. patients receive self-measured blood pressure tools, training, and monitoring). There is strong evidence of effectiveness for these interventions when combined with additional support (i.e. patient counselling, education, or web-based support). The economic evidence indicates that self-measured blood pressure monitoring interventions are cost-effective when they are used with additional support or within team-based care."]
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[null,"Flodgren  G et al. Interactive telemedicine: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD002098. DOI: 10.1002/14651858.CD002098.pub2.\nAvailable here. ","Participants with any chronic condition (including those with hypertension).","This Cochrane review aimed to assess the effectiveness, acceptability and costs of interactive telemedicine as an alternative, or in addition to, usual care (i.e. face-to-face care or telephone consultation). \n\nNinety-three trials were included in the review (n=22,047 participants) which evaluated the effectiveness of interactive telemedicine delivered in addition to (32% of studies), as an alternative to (57% of studies), or partly substituted for usual care (11%) as compared to usual care alone. Four studies were in participants with hypertension.\n\nIn the studies assessing telemedicine in patients with hypertension, blood pressure measurement varied among studies at follow‐up. One study (n = 387) reported a greater decrease in mean SBP in telemedicine delivered care in addition to usual care, as compared with usual care alone at 12 months; one study (n = 236) reported no differences in diastolic daytime and night time ambulatory blood pressure (ABPM) between groups at six months but did report that a greater proportion of intervention patients achieved a target BP at six months. One study (n = 121) reported a greater decrease in 24‐hour systolic and diastolic ABPM and a greater change in mean BP in the telemedicine group at eight weeks, as compared with control. In one monitoring study with automated review of data with alerts (n = 329), the authors reported a greater proportion of telemedicine participants achieving daytime normalisation of arterial BP as compared with control.","The findings in our review indicate that the use of telemedicine in the management of heart failure appears to lead to similar health outcomes as face‐to‐face or telephone delivery of care; there is evidence that telemedicine can improve the control of blood glucose in those with diabetes. The cost to a health service and acceptability by patients and healthcare professionals, is not clear due to limited data reported for these outcomes. The effectiveness of telemedicine may depend on a number of different factors, including those related to the study population e.g. the severity of the condition and the disease trajectory of the participants, the function of the intervention e.g., if it is used for monitoring a chronic condition, or to provide access to diagnostic services, as well as the healthcare provider and healthcare system involved in delivering the intervention."]
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[null,"Hartley  L et al. Vitamin K for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD011148. DOI: 10.1002/14651858.CD011148.pub2.\nAvailable here. ","Healthy adults or adults at high risk of cardiovascular disease. ","This Cochrane review aimed to determine the effectiveness of vitamin K supplementation as a single nutrient supplement for the primary prevention of cardiovascular disease. \n\nOnly one small trial (60 participants randomised) was included in the review, which overall was judged to be at low risk of bias. The study examined two doses of menaquinone (vitamin K2) over three months in healthy participants aged 40 to 65 years. The primary focus of the trial was to examine the effects of menaquinone (subtype MK7) on different matrix Gla proteins (MGP ‐ vitamin K dependent proteins in the vessel wall) at different doses, but the study authors also reported blood pressure and lipid levels. The trial did not report on review primary outcomes (cardiovascular disease clinical events) as it was small, short term and conducted in healthy participants. \n\nIn terms of cardiovascular disease risk factors, no effects were seen for vitamin K2 on blood pressure or lipid levels, although the trial was small and findings are limited. The trial did not report any of the other secondary outcomes for this review. \n","The very limited results of this review highlight the lack of evidence currently available to determine the effectiveness of vitamin K supplementation for the primary prevention of cardiovascular disease and demonstrate the need for further high quality trials in this area. "]
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[null,"Hartley  L et al. Qigong for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2015, Issue 6. Art. No.: CD010390. DOI: 10.1002/14651858.CD010390.pub2.\nAvailable here. ","Healthy adults or adults at high risk of CVD. ","This Cochrane review aimed to determine the effectiveness of qigong for the primary prevention of CVD. Qigong involves physical exercise, mind regulation and breating control to restore the flow of Qi (a pivotal life energy). It is hypothesised that qigong can help to relieve stress and therefore may be effective in the primary prevention of CVD. \n\nThe review authors identified 11 completed trials (1369 participants) and one ongoing trial. Trials were heterogeneous in participants recruited, qigong duration and length of follow‐up periods. The review authors were unable to ascertain the risk of bias in nine trials published in Chinese, as insufficient methodological details were reported and they were unable to contact the study authors to clarify this. \n\nThe review authors did not perform a meta‐analyses, as trials were small and were at significant risk of bias. Clinical events were detailed in subsequent reports of two trials when statistically significant effects of qigong were seen for all‐cause mortality, stroke mortality and stroke incidence at 20 to 30 years after completion of the trials. However, these trials were designed to examine outcomes in the short term and it is not clear whether qigong was practised during extended periods of follow‐up; therefore effects cannot be attributed to the intervention. None of the included studies reported other non‐fatal CVD events. \n\nSix trials provided data that could be used to examine the effects of qigong on blood pressure. Reductions in SBP and DBP were seen in three and two trials, respectively. Three trials examined the effects of qigong on blood lipids when favourable effects were seen in one trial for total cholesterol, low‐density lipoprotein cholesterol and triglycerides and two trials showed favourable effects on high‐density lipoprotein cholesterol. The only trial considered at low risk of selection and detection bias did not demonstrate statistically significant effects on CVD risk factors with qigong, but this study was small and was underpowered. None of the included studies reported incidence of type 2 diabetes, adverse events, quality of life or costs. \n","Currently, very limited evidence is available on the effectiveness of qigong for the primary prevention of CVD. Most of the trials included in this review are likely to be at high risk of bias, so we have very low confidence in the validity of the results. Publication of the ongoing trial will add to the limited evidence base, but further trials of high methodological quality with sufficient sample size and follow‐up are needed to be incorporated in an update of this review before the effectiveness of qigong for CVD prevention can be established."]
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[null,"Martin  N et al. Nut consumption for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD011583. DOI: 10.1002/14651858.CD011583.pub2.\nAvailable here. ","Healthy adults or adults at moderate and high risk of CVD. ","This Cochrane review aimed to determine the effectiveness of nut consumption for the primary prevention of CVD. \n\nFive trials (435 participants randomised) and one ongoing trial were included in the review. One study is awaiting classification. All trials examined the provision of nuts to increase consumption rather than dietary advice. Blood pressure change was a secondary outcome of the review. The results are reported below:\n\nThree trials (267 participants) measured mean change in systolic and DBP (mm Hg) from baseline to last follow‐up, which was three months in two trials and 12 weeks for one trial (with two trial arms). For SBP heterogeneity was substantial between trials (I² = 55%) using a random‐effects model. There was no statistically significant effect of nut consumption on SBP (MD 3.22 mm Hg, 95% CI ‐2.70 to 9.14; p = 0.29). However, one trial was a clear outlier with an extremely large reduction in SBP in the control arm during the trial period of 14 mm Hg. Excluding this trial from the sensitivity analysis gave a MD of ‐0.28 mm Hg (95% CI ‐5.79 to 5.23; p = 0.92). \n\nFor DBP, because of the substantial heterogeneity (I² = 87%) the pooled effect estimate was suppressed and results from individual trials are plotted. One trial showed a statistically significant reduction, one trial with two arms showed a statistically significant increase in DBP with the intervention and the remaining trial showed no effect of the intervention. \n","The review authors conclude that currently there is a lack of evidence for the effects of nut consumption on CVD, clinical events in primary prevention and very limited evidence for the effects on CVD risk factors. No conclusions can be drawn and further high quality longer term and adequately powered trials are needed to answer the review question. "]
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[null,"Hartley  L et al. Tai chi for primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2014, Issue 4. Art. No.: CD010366. DOI: 10.1002/14651858.CD010366.pub2.\nAvailable here.","Healthy adults or adults at high risk of CVD. ","This Cochrane review attempted to determine the effectiveness of tai chi for the primary prevention of CVD. \n\nThirteen small trials were identified (1,520 participants randomised) and three ongoing trials. All studies had at least one domain with unclear risk of bias, and some studies were at high risk of bias for allocation concealment (one study) and selective reporting (two studies). Duration and style of tai chi differed between trials. Seven studies recruited 903 healthy participants, the other studies recruited people with borderline hypertension or hypertension, elderly people at high risk of falling, and people with hypertension with liver and kidney yin deficiency syndrome.\n\nNo studies reported on cardiovascular mortality, all‐cause mortality or non‐fatal events as most studies were short term (all studies had follow‐up of one year or less). There was also considerable heterogeneity between studies, which meant that it was not possible to combine studies statistically for cardiovascular risk (I2 statistic for SBP was 96%, for DBP 96%, for total cholesterol 96%, low‐density lipoprotein‐cholesterol 95%, high‐density lipoprotein‐cholesterol 98%, triglycerides 75%). Nine trials measured blood pressure, six individual trials found reductions in SBP (reductions ranged from ‐22.0 mm Hg (95% confidence interval (CI) ‐26.3 to ‐17.7) to ‐11.5 mm Hg (95% CI ‐21.5 to ‐1.46)), two trials found no clear evidence of a difference (however, CIs were wide and an increase or decrease in SBP cannot be ruled out) and one trial found an increase in SBP with tai chi (increase 5.2 mm Hg, 95% CI 3.73 to 6.67). A similar pattern was seen for DBP: three trials found a reduction in DBP (reductions ranged from ‐12.2 mm Hg (95% CI ‐15.8 to ‐8.7) to ‐4.43 mm Hg (95% CI ‐7.14 to ‐1.72)) and three trials found no clear evidence of a difference, however again with wide CIs. ","There are currently no long‐term trials examining tai chi for the primary prevention of CVD. Due to the limited evidence available currently no conclusions can be drawn as to the effectiveness of tai chi on CVD risk factors. There was some suggestion of beneficial effects of tai chi on CVD risk factors but this was not consistent across all studies. There was considerable heterogeneity between the studies included in this review and studies were small and at some risk of bias. Results of the ongoing trials will add to the evidence base but additional longer‐term, high‐quality trials are needed."]
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[null,"Seron  P et al. Exercise for people with high cardiovascular risk. Cochrane Database of Systematic Reviews 2014, Issue 8. Art. No.: CD009387. DOI: 10.1002/14651858.CD009387.pub2\nAvailable here. ","Adults with an average 10-year Framinghan risk score of 10% for cardiovascular disease over 10 years, or with two or more cardiovascular risk factors and no history of cardiovascular disease. ","This Cochrane review aimed to assess the effects of exercise training in people with increased cardiovascular risk but without a concurrent cardiovascular disease on general cardiovascular mortality, incidence of cardiovascular events and total cardiovascular risk. \n\nA total of four studies were included that involved 823 participants, 412 in the exercise group and 411 in the control group. Follow‐up of participants ranged from 16 weeks to six months. Overall, the included studies had a high risk of selection, detection and attrition bias. Meta‐analysis was not possible because the interventions (setting, type and intensity of exercise) and outcome measurements were not comparable and the risk of bias in the identified studies was high. No study assessed cardiovascular or all‑cause mortality or cardiovascular events as individual outcomes. Blood pressure was a secondary outcome in the review and the results are described below:\n\nThree studies assessed the systolic and DBP levels; two of them found significant differences between the study arms that were not clinically important. \n\nFor SBP, one study reported a difference from baseline of ‐5 mm Hg (95% CI ‐9 to ‐0.3) by the end of six months in the exercise group, which was higher than the ‐1 mm Hg (95% CI ‐3 to 1) difference in the control group (p < 0.05). The other study found a difference of ‐8.30 mm Hg (95% CI ‐9.97 to ‐6.63) in the exercise group, which was higher than the ‐6.17 mm Hg (95% CI ‐7.60 to ‐4.74) difference in the control group. The difference between groups at the end of the follow‐up period, adjusted by the baseline measurement, was ‐2.46 mm Hg (95% CI ‐4.50 to ‐0.42) (p = 0.018).\n\nFor DBP, the first study reported a difference between the baseline measurement and that performed by the end of the intervention of ‐4 mm Hg (95% CI ‐7 to ‐2) in the exercise group, which was greater than the ‐1 mm Hg (95% CI ‐3 to 1) difference in the control group (p < 0.05). The second study showed a ‐4.77 mm Hg (95% CI ‐5.72 to ‐3.83) and a ‐3.60 mm Hg (95% CI ‐4.44 to ‐2.76) difference in the exercise and the control groups, respectively. The difference between groups at the end of six months of follow‐up, adjusted by the baseline measurement, was ‐1.4 (95% CI ‐2.6 to ‐0.2) (p = 0.019). \n\nThe third study assessing blood pressure found no differences between the study groups for systolic and DBP. \n","Evidence to date is entirely limited to small studies with regard to sample size, short‐term follow‐up, and high risk of methodological bias, which makes it difficult to derive any conclusions on the efficacy or safety of aerobic or resistance exercise on groups with increased cardiovascular risk or in individuals with two or more coexisting risk factors. Further randomised clinical trials assessing controlled exercise programmes on total cardiovascular risk in individuals are warranted."]
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[null,"Hartley  L et al. Yoga for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2014, Issue 5. Art. No.: CD010072. DOI: 10.1002/14651858.CD010072.pub2.\nAvailable here. ","Healthy adults or those at high risk of CVD. ","This Cochrane review aimed to determine the effect of any type of yoga on the primary prevention fo CVD. \n\nEleven trials were identified (800 participants) and two ongoing studies. Style and duration of yoga differed between trials. Half of the participants recruited to the studies were at high risk of CVD. Most of studies were at risk of performance bias, with inadequate details reported in many of them to judge the risk of selection bias.  \n\nNo study reported cardiovascular mortality, all‐cause mortality or non‐fatal events, and most studies were small and short‐term. Blood pressure was a secondary outcome in the review and the results are reported below: \n\nNine of the 11 included studies measured blood pressure. Useable data for meta‐analysis were not available for one study, as no data for the control group were provided, only changes since baseline for the yoga group. In this study, SBP was significantly reduced by yoga (mean difference (MD) ‐5.71 mm Hg, p < 0.01) and DBP was also reduced but this did not reach statistical significance (mean difference ‐3.71 mm Hg, p reported to be non‐significant). The other eight studies could not be combined as there was substantial heterogeneity between trials (I2 = 81%) (485 participants). Two studies showed a significant reduction in SBP with the intervention, and six studies showed yoga to reduce SBP but this did not reach statistical significance. The remaining study showed a significant increase in SBP (MD 2.20, 95% confidence interval (CI) 0.16 to 4.24).\n\nFor DBP (444 participants), we found moderate heterogeneity between studies (I2 = 58%) so we performed a random‐effects meta‐analysis. From the pooled analysis, yoga was found to significantly lower DBP (MD ‐2.90, 95% CI ‐4.52 to ‐1.28). Results were similar for the fixed‐effect model but review authors reported the random‐effects results as the effect estimate is more conservative with wider confidence intervals. Sensitivity analysis, removing studies with high risk of bias based on incomplete outcome data (those with loss to follow‐up of more than 20% without intention‐to‐treat analysis), retained seven studies and statistical significance (MD ‐3.38 mm Hg, 95% CI ‐4.88 to ‐1.88).\n ","The limited evidence comes from small, short‐term, low‐quality studies. There is some evidence that yoga has favourable effects on DBP, HDL cholesterol and triglycerides, and uncertain effects on LDL cholesterol. These results should be considered as exploratory and interpreted with caution."]
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[null,"Neary M et al. Screening for hypertension. Ottawa, Ontario: Canadian Task Force on Preventive Health Care; 2014. \nAvailable here. ","Adults aged 18+ from the general population including subsets with higher than average risk of hypertension, vascular risk and average baseline blood pressure. ","This review aimed to summarise the evidence on screening for hypertension (detecting undiagnosed hypertension) in primary care. The review aims to determine the effectiveness of hypertension screening in primary care in reducing the risk of cardiovascular events and all-cause mortality. Determining the effectiveness of screening in reducing blood pressure (BP) is a subsidiary aim. The harms of hypertension screening – excluding harms caused by treatment – were also  reviewed.\n\nThis review found no controlled studies of the effectiveness of screening for\nhypertension in primary care. It did find one cluster randomised trial assessing whether a community-based cardiovascular screening program that included hypertension screening is superior to usual screening practice and one modelling study that met inclusion criteria for studies on the benefits of hypertension screening. There were no studies that met the inclusion criteria for identifying the optimal frequency and/or timing of screening for identifying patients who might benefit from treatment, nor for identifying specific criteria that should trigger an increase\nin the frequency of screening. No studies that met the inclusion criteria were found to address the harms ranked ‘critical’ by the Hypertension Working Group. However, two papers (and one companion paper) of interest were identified regarding the consequences of informing patients of a new diagnosis of hypertension.\n\n","In this review, there were no studies identified that specifically and directly assessed whether screening for hypertension in primary care practice reduces the risk of\ncardiovascular morbidity, cardiovascular mortality, and all-cause mortality and/or whether it\nleads to sustained reductions in blood pressure. There were no studies identified that assessed whether measuring blood pressure at most clinical encounters in primary care achieved the desired cardiovascular morbidity or mortality outcomes or sustained reductions in blood pressure. However, in light of some evidence for benefit from a more intense (cardiovascular) screening program that included hypertension screening and the overwhelming evidence that treating patients diagnosed with hypertension improves patient outcomes, there is indirect evidence to support screening for hypertension by measuring blood pressure in most primary care encounters rather than screening less frequently. "]
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[null,"Peirson L et al. Prevention of overweight/obesity in adult populations: a systematic review with meta-analyses. Ottawa, Ontario: Canadian Task Force on Preventive Health Care; 2014.\nAvailable here. ","Adults of normal weight (BMI >18 and <25) In the absence of this statement the authors accepted studies when the baseline mean BMI minus one standard deviation (SD) fell below 25 kg/m2; they assumed that this result meant there were some normal weight people in the sample.","The review aimed to synthesise evidence on behavioural interventions for preventing weight gain in normal weight adults. Blood pressure change was a secondary outcome of the review and the results are reported below: \n\nSeventeen RCTs (n=48,493) of very low GRADE quality (downgraded for risk of bias, inconsistency, indirectness and imprecision) were included in the meta-analysis assessing change in SBP. Across these studies, baseline BMI ranged from 22.4 to 31.1; in four of the studies the baseline mean BMI of at least one study arm was <25; in 13 studies the baseline means were in the range for overweight/obese. In terms of type of intervention three were diet, three were exercise, three were diet plus exercise, and eight were lifestyle. Control participants received usual care from their physicians or no intervention; in five of these studies control participants received a minimal component (e.g. printed materials on healthy lifestyles). Intervention duration was 12 months or less in 12 studies and more than 12 months in five studies. There was no difference between intervention and control group participants in terms of change in SBP [MD (95% CI) -0.31 mm Hg (-0.84, 0.22); I2=77%]. \n\nFifteen RCTs (n=47,945) of very low GRADE quality (downgraded for risk of bias, inconsistency, indirectness and imprecision) were included in the meta-analysis assessing change in DBP. Across these studies, baseline BMI ranged from 22.4 to 31.1; in four of the studies the baseline mean BMI of at least one study arm was <25; in 11 studies the baseline means were in the range for overweight/obese. In terms of type of intervention three were diet, two were exercise, three were diet plus exercise and seven were lifestyle. Control participants received usual care from their physicians or no intervention; in five of these studies control participants received a minimal component (e.g. printed materials on healthy lifestyles). Intervention duration was 12 months or less in 10 studies and more than 12 months in five studies. There was no difference between intervention and control group participants in terms of change in DBP [MD (95% CI) -0.18 mm Hg (-0.44, 0.07); I2=66%]. \n\n","There is low quality evidence that behavioural interventions are associated with reductions in weight and improvements in other health outcomes in mixed weight adult populations, but it is uncertain whether the benefits are clinically meaningful and can be maintained over time. In the short term, strategies aimed at weight maintenance appear to have some benefit; if maintained, these could be clinically significant benefits.\n\nThe review authors state that results presented for secondary health outcomes (including blood pressure) should be interpreted with caution as they only included interventions that had a focus on weight gain prevention. "]
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[null,"Canadian Agency for Drugs and Technologies in Health\nObesity Management Interventions Delivered in Primary Care for Patients with Hypertension or Cardiovascular Disease: A Review of Clinical Effectiveness 2014 Jul 9. \nAvailable here","Adults with body-mass-index (BMI) of 30 or higher who have hypertension or cardiovascular disease (CVD) or both.","Greater weight loss correlated positively with greater reductions in blood pressure and cardiovascular risk factors regardless of which weight loss intervention was used. Dietary only interventions achieved greater initial weight loss than physical activity only interventions with the greatest weight loss occurring around 6 months. However, only lifestyle interventions that combine dietary changes and physical activity have been shown to produce significant differences in weight loss beyond 12 months. \n\nA lifestyle intervention and comprehensive metabolic risk factor management program resulted in weight loss associated with a substantial reduction in the symptom burden and symptom severity of atrial fibrillation. \n\nMotivational Interviewing (MI) was effective in bringing about long-term improvements in walking, and cholesterol levels, and was particularly effective for patients with elevated baseline levels of CVD risk factors. \n\nIn overweight or obese individuals at increased cardiovascular risk, Mediterranean diets appear to be more effective than low-fat diets in inducing clinically relevant long-term changes in cardiovascular risk factors and inflammatory markers, with evidence from one study demonstrating a lasting benefit of Mediterranean diets for 2 years after the beginning of the diet.","The pharmacological weight loss intervention studies demonstrated significantly greater weight reductions in obese patient compared to lifestyle interventions alone. \n\nLifestyle interventions for weight loss that combined diet and exercise were more successful at achieving targeted weight loss goals than diet-only interventions or physical activity-only intervention. Also, MI counselling intervention was demonstrated to be an effective tool to promote lifestyle changes leading to greater weight loss than a one-time provision of written information about diet and exercise. \n\nSignificant weight loss (≥5%) was associated with health benefits including reduction in blood pressure, both systolic and diastolic, as well as reductions in cardiovascular risk factors, including hyperglycemia, and dyslipidemia, and reduced use of concomitant medications. The degree of health benefits positively correlated with the degree of weight loss regardless of the intervention used. \n\nWith regards to dietary weight loss programs, evidence from a meta-analysis indicated that Mediterranean diets appear to be more effective than low-fat diets in inducing clinically relevant long-term changes in cardiovascular risk factors and inflammatory markers."]
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[null,"He  FJ et al. Effect of longer‐term modest salt reduction on blood pressure. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD004937. DOI: 10.1002/14651858.CD004937.pub2.\nAvailable here. ","Adults with normal or raised blood pressure. ","This Cochrane review aimed to assess (1) the effect of long-term modest reduction in salt intake on BP and whether there was a dose-response relationship; (2) the effect on BP by sex and ethnic group; (3) the effect on plasma renin activity, aldosterone, noradrenaline, adrenaline, cholesterol, low‐density lipoprotein (LDL), high‐density lipoprotein (HDL) and triglycerides. \n\nThirty‐four trials (3,230 participants) were included. Meta‐analysis showed that the mean change in urinary sodium (reduced salt vs usual salt) was ‐75 mmol/24‐h (equivalent to a reduction of 4.4 g/d salt), the mean change in BP was ‐4.18 mm Hg (95% CI: ‐5.18 to ‐3.18, I2=75%) for systolic and ‐2.06 mm Hg (95% CI: ‐2.67 to ‐1.45, I2=68%) for diastolic BP. Meta‐regression showed that age, ethnic group, BP status (hypertensive or normotensive) and the change in 24‐h urinary sodium were all significantly associated with the fall in systolic BP, explaining 68% of the variance between studies. A 100 mmol reduction in 24 hour urinary sodium (6 g/day salt) was associated with a fall in systolic BP of 5.8 mm Hg (95%CI: 2.5 to 9.2, p=0.001) after adjusting for age, ethnic group and BP status. For diastolic BP, age, ethnic group, BP status and the change in 24‐h urinary sodium explained 41% of the variance between studies. Meta‐analysis by subgroup showed that, in hypertensives, the mean effect was ‐5.39 mm Hg (95% CI: ‐6.62 to ‐4.15, I2=61%) for systolic and ‐2.82 mm Hg (95% CI: ‐3.54 to ‐2.11, I2=52%) for diastolic BP. In normotensives, the mean effect was ‐2.42 mm Hg (95% CI: ‐3.56 to ‐1.29, I2=66%) for systolic and ‐1.00 mm Hg (95% CI: ‐1.85 to ‐0.15, I2=66%) for diastolic BP. Further subgroup analysis showed that the decrease in systolic BP was significant in both whites and blacks, men and women. Meta‐analysis of hormone and lipid data showed that the mean effect was 0.26 ng/ml/hr (95% CI: 0.17 to 0.36, I2=70%) for plasma renin activity, 73.20 pmol/l (95% CI: 44.92 to 101.48, I2=62%) for aldosterone, 31.67 pg/ml (95% CI: 6.57 to 56.77, I2=5%) for noradrenaline, 6.70 pg/ml (95% CI: ‐0.25 to 13.64, I2=12%) for adrenaline, 0.05 mmol/l (95% CI: ‐0.02 to 0.11, I2=0%) for cholesterol, 0.05 mmol/l (95% CI: ‐0.01 to 0.12, I2=0%) for LDL, ‐0.02 mmol/l (95% CI: ‐0.06 to 0.01, I2=16%) for HDL, and 0.04 mmol/l (95% CI: ‐0.02 to 0.09, I2=0%) for triglycerides.","A modest reduction in salt intake for four or more weeks causes significant and, from a population viewpoint, important falls in BP in both hypertensive and normotensive individuals, irrespective of sex and ethnic group. With salt reduction, there is a small physiological increase in plasma renin activity, aldosterone and noradrenaline. There is no significant change in lipid levels. These results provide further strong support for a reduction in population salt intake. This will likely lower population BP and, thereby, reduce cardiovascular disease. Additionally, our analysis demonstrates a significant association between the reduction in 24‐h urinary sodium and the fall in systolic BP, indicating the greater the reduction in salt intake, the greater the fall in systolic BP. The current recommendations to reduce salt intake from 9‐12 to 5‐6 g/d will have a major effect on BP, but are not ideal. A further reduction to 3 g/d will have a greater effect and should become the long term target for population salt intake."]
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[null,"Desroches  S et al. Interventions to enhance adherence to dietary advice for preventing and managing chronic diseases in adults. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD008722. DOI: 10.1002/14651858.CD008722.pub2\nAvailable here. ","Adults participating in chronic disease prevention or chronic disease management studies involving dietary advice. ","This Cochrane review aimed to assess the effects of interventions for enhancing adherence to dietary advice for preventing and managing chronic diseases in adults. \n\nThirty-eight studies were included in the review involving 9,445 participants. Five studies addressed the management of hypertension:\n\nOne study assessed the effects of telephone follow‐up on: adherence to a sodium‐restricted diet; fat intake and fruit and vegetable intake, in clients with hypertension. The study authors reported no differences in diet adherence between the intervention group and the control group at eight weeks. However, a greater decrease in systolic and DBP was observed in the intervention group compared to the control group as well as a greater increase in exercise adherence. \n\nAnother study also evaluated the effects of telephone follow‐up on adherence to a sodium‐restricted diet in clients with hypertension. The authors reported that a higher proportion of clients adhered to the sodium‐restricted diet at 24 weeks in the intervention group compared to the control group, but the difference was no longer significant at 36 weeks. No differences were found in systolic and DBP between groups. The authors also noted no difference in non‐adherence to alcohol intake at 24 and 36 weeks between groups.\n\nOne study assessed the effects of feedback using self‐monitoring of urine chloride concentration on adherence to a sodium‐restricted diet in clients with hypertension. No difference was reported in adherence to the sodium‐restricted diet or in blood pressure between the intervention group and the control group at one and three months.\n\nOne study evaluated the effects of wheels and bar charts displaying cognitive representations of the DASH diet as a nutritional tool on adherence to the DASH diet in clients with hypertension compared to a control group. The study authors reported results grouped for both groups, making comparison between groups impossible.\n\nThe final study assessed the effectiveness of an intervention using telephone follow‐up combined with motivational interviewing, comparing two interventions in clients with hypertension with a usual care group: 1) simultaneous behaviour change (stop smoking, reduce dietary sodium level and increase physical activity) and 2) sequential behaviour change (stop smoking, then reduce dietary sodium levels and finally increase physical activity). A higher proportion of clients adhered to the sodium‐restricted diet in the simultaneous group, compared to the sequential intervention and the usual care group at six months, but no difference was observed at 18 months. No difference was reported for blood pressure between groups.","The authors conclude that there is a need for further, long‐term, good‐quality studies using more standardised and validated measures of adherence to identify the interventions that should be used in practice to enhance adherence to dietary advice in the context of a variety of chronic diseases."]
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[null,"Hartley  L et al. Green and black tea for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD009934. DOI: 10.1002/14651858.CD009934.pub2.\nAvailable here. ","Healthy adults or those at high risk of CVD. ","This Cochrane review aimed to determine the effects of green and black tea on the primary prevention of CVD. \n\nEleven RCTs (821 participants), two trials awaiting classification and one ongoing trial were identified. Seven trials examined a green tea intervention and four examined a black tea intervention. Dosage and form of both green and black tea differed between trials. The ongoing trial is examining the effects of green tea powder capsules. Blood pressure was a secondary outcome of the review, the results are reported below:\n\nBlack tea:\nTwo trials examined the effect of black tea on blood pressure. The meta‐analysis (123 participants) showed a statistically significant reduction in SBP (MD ‐1.85 mm Hg, 95% CI ‐3.21 to ‐0.48). DBP (123 participants) was also reduced with the black tea intervention, however, this result did not reach statistical significance (MD ‐1.27 mm Hg, 95% CI ‐3.06 to 0.53). \n\nGreen tea:\nThree trials examining green tea measured blood pressure but one did not provide any individual group data and could not be included in a meta‐analysis. The pooled analysis showed a statistically significant reduction in SBP (167 participants) (MD ‐3.18 mm Hg, 95% CI ‐5.25 to ‐1.11) and DBP (167 participants) (MD ‐3.42, 95% CI ‐4.54 to ‐2.30) in the green tea group. The trial not included in the meta‐analysis showed no significant change in blood pressure in either the tea (SBP change 1.10%, DBP change ‐7.20%) or control group (SBP decrease 0%, DBP decrease 1.10%). \n\nAll tea (green and black):\nFive trials (three using green tea and two using black tea) measured blood pressure. Only four of these contributed to the meta‐analysis as one trial did not report individual group data. The meta‐analysis showed a statistically significant reduction in SBP (290 participants) (MD ‐2.25 mm Hg, 95% CI ‐3.39 to ‐1.11) and DBP (290 participants) (MD ‐2.81 mm Hg, 95% CI ‐3.77 to ‐1.86) with the tea intervention. ","There are very few long‐term studies to date examining green or black tea for the primary prevention of CVD. The limited evidence suggests that tea has favourable effects on CVD risk factors, but due to the small number of trials contributing to each analysis the results should be treated with some caution and further high quality trials with longer‐term follow‐up are needed to confirm this. "]
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[null,"Hartley  L et al. Increased consumption of fruit and vegetables for the primary prevention of cardiovascular diseases. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD009874. DOI: 10.1002/14651858.CD009874.pub2.\nAvailable here. ","Healthy adults or those at high risk of CVD. ","This Cochrane review aimed to determine the effectiveness of 1) advice to increase fruit and vegetable consumption and 2) the provision of fruit and vegetables to increase consumption, for the primary prevention of CVD.\n\nTen trials (n=1,730) and one ongoing trial were identified. Six trials investigated the provision of fruit and vegetables and four trials examined advice to increase fruit and vegetable consumption. The ongoing trial is examining the provision of an avocado‐rich diet. The number and type of intervention components for provision and the dietary advice provided differed between trials.  Change in BP was a secondary outcome of the review, the results are described below:\n\nTwo of the four studies that examined dietary advice to increase the consumption of fruit and vegetables measured blood pressure. In one study, this was at six months and in the other study at 12 months. From the pooled analysis, advice to eat fruit and vegetables significantly reduced SBP (mean difference (MD) ‐3.0 mm Hg (95% confidence interval (CI) ‐4.92 to ‐1.09; 891 participants) but the reduction in DBP was not statistically significant (MD ‐0.90 mm Hg (95% CI ‐2.03 to 0.24; 891 participants). No heterogeneity was found between trials (I2 = 0%).  \n\nFour of the five studies that examined the provision of fruit and vegetables to increase consumption measured blood pressure. One reported medians and interquartile ranges suggesting the data were skewed, and authors of two studies were contacted for information on mean changes and variance but this was not forthcoming. Two studies also did not provide information on effect size or statistical significance.\n\nDifferences were seen for diastolic blood pressure in women with metabolic syndrome in both the intervention and control group (P < 0.05). (30 participants) at 90 days. One study reported no effects on systolic (MD 1.00 mmHg, 95% CI 0.45 to 1.55) (Analysis 2.1) or diastolic blood pressure (MD 1.50 mmHg, 95% CI 1.18 to 1.82) (Analysis 2.2) with the provision of fruit and vegetables to increase consumption (157 participants) at three months. The remaining two studies also reported no effects on blood pressure with the provision of fruit and vegetables to increase consumption (180 participants) at three months and six months. \n","There are very few studies to date examining provision of, or advice to increase the consumption of, fruit and vegetables in the absence of additional dietary interventions or other lifestyle interventions for the primary prevention of CVD. The limited evidence suggests advice to increase fruit and vegetables as a single intervention has favourable effects on CVD risk factors but more trials are needed to confirm this. "]
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[null,"Rees  K et al. Dietary advice for reducing cardiovascular risk. Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.: CD002128. DOI: 10.1002/14651858.CD002128.pub5.\nAvailable here. ","Healthy adults","This Cochrane review aimed to assess the effects of providing dietary advice to achieve sustained dietary changes or improved cardiovascular risk profile among healthy adults.\n\nForty‐four trials with 52 intervention arms (comparisons) comparing dietary advice with no advice were included in the review; 18,175 participants or clusters were randomised. Twenty‐nine of the 44 included trials were conducted in the USA. Dietary advice reduced total serum cholesterol by 0.15 mmol/L (95% CI 0.06 to 0.23) and LDL cholesterol by 0.16 mmol/L (95% CI 0.08 to 0.24) after three to 24 months. Mean HDL cholesterol levels and triglyceride levels were unchanged. Dietary advice reduced blood pressure by 2.61 mm Hg systolic (95% CI 1.31 to 3.91) and 1.45 mm Hg diastolic (95% CI 0.68 to 2.22) and 24‐hour urinary sodium excretion by 40.9 mmol (95% CI 25.3 to 56.5) after three to 36 months but there was heterogeneity between trials for the latter outcome. Three trials reported plasma antioxidants, where small increases were seen in lutein and β‐cryptoxanthin, but there was heterogeneity in the trial effects. Self‐reported dietary intake may be subject to reporting bias and there was significant heterogeneity in all the following analyses. Compared to no advice, dietary advice increased fruit and vegetable intake by 1.18 servings/day (95% CI 0.65 to 1.71). Dietary fibre intake increased with advice by 6.5 g/day (95% CI 2.2 to 10.82), while total dietary fat as a percentage of total energy intake fell by 4.48% (95% CI 2.47 to 6.48) with dietary advice and saturated fat intake fell by 2.39% (95% CI 1.4 to 3.37). \n\nTwo trials analysed incident cardiovascular disease (CVD) events. Follow‐up was 77% complete at 10 to 15 years after the end of the intervention period and estimates of event rates lacked precision but suggested that sodium restriction advice probably led to a reduction in cardiovascular events (combined fatal plus non‐fatal events) plus revascularisation (study 1 hazard ratio (HR) 0.59, 95% CI 0.33 to 1.08; study 2 HR 0.81, 95% CI 0.59 to 1.12). \n","Dietary advice appears to be effective in bringing about modest beneficial changes in diet and cardiovascular risk factors over approximately 12 months, but longer‐term effects are not known"]
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[null,"Freak‐Poli  RLA et al. Workplace pedometer interventions for increasing physical activity. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD009209. DOI: 10.1002/14651858.CD009209.pub2.\nAvailable here. ","Employed adults.","This Cochrane review aimed to assess the effectiveness of pedometer interventions in the workplace for increasing physical activity and improving subsequent health outcomes. \n\nFour studies were included providing data for 1,809 employees, 60% of whom were allocated to the intervention group. All studies assessed outcomes immediately after the intervention had finished and the intervention duration varied between three to six months. All studies had usual treatment control conditions; however one study's usual treatment was an alternative physical activity programme while the other three had minimally active controls. In general, there was high risk of bias mainly due to lack of blinding, self reported outcome measurement, incomplete outcome data due to attrition, and most of the studies had not published protocols, which increases the likelihood of selective reporting. Change in BP was a secondary outcome of the review and the results are below:\n\nPedometer programme vs 'no intervention' control:\nTwo studies reported change from baseline for systolic and DBP. Meta‐analyses showed that there were no significant differences between the pedometer programme and the control group for SBP (MD ‐3.11 mm Hg, 95% CI ‐8.39 to 2.17) or DBP (MD ‐1.14 mm Hg, 95% CI ‐3.45 to 1.16). \n\nPedometer programme vs alternative programme without pedometer:\nOne study did not find a statistically significant difference between the pedometer programme and alternative physical activity programme for blood pressure at the end of the programme (systolic MD ‐4.00 mm Hg, 95% CI ‐10.15 to 2.15; diastolic MD ‐2.20 mm Hg, 95% CI ‐6.74 to 2.34; baseline MD: systolic ‐5.5, diastolic ‐2.8). ","There was limited and low quality data providing insufficient evidence to assess the effectiveness of pedometer interventions in the workplace for increasing physical activity and improving subsequent health outcomes. "]
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[null,"Community Preventive Services Task Force. Cardiovascular Disease Prevention: Team based care to improve blood pressure control. Task Force Findings and Rationale Statement; 2012.\nAvailable here.\n\nLast updated July 16, 2014. ","Hypertensive patients.","This Community Preventive Services Task Force review looks at team-based care to improve blood pressure control. \n\nThe Task Force finding is based on evidence from a systematic review published in 2006 (28 studies, search period January 1980-July 2003) and a more recent Community Guide review (52 studies, search period July 2003-May 2012). Results from both reviews demonstrate the effectiveness of team-based care (TBC) in improving blood pressure outcomes.\n\nFrom the current review, the predominant team members who worked with patients and primary care providers were nurses (28 studies), pharmacists (15 studies), or both (five studies). When pharmacists were added to teams, the median improvement in the proportion of patients with controlled blood pressure was considerably higher than the overall median increase for this outcome. Median reductions in SBP and DBP were similar to overall estimates. When nurses or both nurses and pharmacists were added to teams, median estimates for all three outcomes were comparable to overall effect estimates. Only four studies examined the effectiveness of adding other team members, such as community health workers, social workers or dietitians without nurses or pharmacists. In these few instances, median effect estimates were smaller in magnitude compared to overall effect estimates. Most studies added one team member; results were similar when compared to studies that added two or more team members, for all three outcomes.\n\nStudies in the current review also examined effectiveness of TBC when team members could make changes to hypertensive medications independent of the primary care provider (16 studies); with primary care provider approval or consultation (15 studies); or not at all (22 studies). The first two levels of medication management achieved larger improvements in blood pressure outcomes when compared to the third level, where team members provided adherence support and hypertension-related information but did not make medication changes or recommendations. Other important team member roles include support for health behaviour change (e.g.  counselling sessions) and systems support mainly via telephone follow-up.","The Community Preventive Services Task Force recommends team-based care to improve blood pressure control on the basis of strong evidence of effectiveness in improving the proportion of patients with controlled blood pressure and in reducing SBP and DBP. Evidence was considered strong based on findings from 80 studies of team-based care organised primarily with nurses and pharmacists working in collaboration with primary care providers, patients and other professionals. The economic evidence indicates that team-based care is cost-effective."]
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[null,"Usinger  L et al. Fermented milk for hypertension. Cochrane Database of Systematic Reviews 2012, Issue 4. Art. No.: CD008118. DOI: 10.1002/14651858.CD008118.pub2.\nAvailable here. ","Adults (age 18+).","This Cochrane review investigated whether fermented milk or similar products produced by lactobacilli fermentation of milk proteins have any blood pressure lowering effect in humans when compared to no treatment or placebo. \n\nFifteen studies were included in the review. The studies were all placebo-controlled and four studies used a cross over design. The length of studies varied from four to 23 weeks with intervention periods of  four to 21 weeks. Most studies were double-blind, but three were single-blind. One study consisted of two different arms where one received a fermented milk with added potassium and the other arm a similar fermented milk without added potassium. Another study had separate intervention groups according to the participants' baseline BP. A further study had three different intervention groups: lactotripeptides (LTP) produced synthetic, enzymatic hydrolysis and bacterial fermentation. Finally, two studies had several intervention groups with different concentration levels of the active product. \n\nAll studies, except one, had industry funding and/or some or all of the authors were employed by private food companies. Similarly in all these studies the test and placebo products were produced by the involved companies. \n\nAn overall effect was found on office SBP (MD ‐2.45; 95% CI ‐4.30, ‐0.60; n=1,232; 15 studies), but no effect on DBP (MD ‐0.67; 95% CI ‐1.48, 0.14; n=1,232; 15 studies). The length of the intervention (more than 8 weeks compared to 4‐8 weeks) did not influence the effect on BP.  After removing the eight studies with high risk of bias significant effects were seen as a result of the intervention on neither SBP (MD ‐0.57 mm Hg; 95% CI ‐3.12 to 1.98) nor DBP (MD ‐0.39 mm Hg; 95% CI ‐1.78 to 1.01). \n","The authors conclude that the review does not support an effect of fermented milk on blood pressure. Despite the positive effect on SBP the authors conclude, for several reasons, that fermented milk has no effect on blood pressure. The effect found was very modest and only on SBP, the included studies were very heterogeneous and several with weak methodology. Finally, sensitivity and subgroup analyses could not reproduce the antihypertensive effect. The results do not support the use of fermented milk as treatment for hypertension or as a lifestyle intervention for pre‐hypertension nor would it influence population blood pressure. "]
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[null,"Zhang  HW et al. Tianma Gouteng Yin Formula for treating primary hypertension. Cochrane Database of Systematic Reviews 2012, Issue 6. Art. No.: CD008166. DOI: 10.1002/14651858.CD008166.pub2.\nAvailable here.","Patients with primary hypertension, including men and non-pregnant women. ","This Cochrane review aimed to assess the efficacy and safety of Tianma Gouteng Yin Formula (TGYF) for treating primary hypertension compared to placebo or no treatment. TGYF, a mixture of herbs,  is widely used to treat hypertension-related symptoms in clinical practice in East Asia\n\nNo studies were identified which met the inclusion criteria for the review. ","As no trials could be identified, no conclusions can be made about the role of TGYF in the treatment of primary hypertension. Well‐designed RCTs need to be conducted and published. "]
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[null,"Stabler  SN et al. Garlic for the prevention of cardiovascular morbidity and mortality in hypertensive patients. Cochrane Database of Systematic Reviews 2012, Issue 8. Art. No.: CD007653. DOI: 10.1002/14651858.CD007653.pub2.\nAvailable here.","Adults with a diagnosis of primary hypertension (defined as having a SBP > 140 mm Hg or a DBP of > 90mm Hg, or both).","This Cochrane review aimed to determine whether the use of garlic as monotherapy, in hypertensive patients, lowers the risk of cardiovascular morbidity and mortality compared to placebo. \n\nThe search identified two RCTs for inclusion. One trial included 47 hypertensive patients and showed that garlic significantly reduces mean supine SBP by 12 mm Hg (95% CI 0.56 to 23.44 mm Hg, p=0.04) and mean supine DBP by 9 mm Hg (95% CI 2.49 to 15.51 mm Hg, p=0.007) versus placebo. The study authors state that garlic was \"free from side effects\" and that no serious side effects were reported. There were three cases \"where a slight smell of garlic was noted.\" \n\nThe second trial could not be meta‐analysed as they did not report the number of people randomised to each treatment group. They did report that 200 mg of garlic powder given three times daily, in addition to hydrochlorothiazide‐triamterene baseline therapy, produced a mean reduction of SBP by 10‐11 mm Hg and of DBP by 6‐8 mm Hg versus placebo. \n\nNeither trial reported clinical outcomes and insufficient data was provided on adverse events. \n\n\n","The authors conclude that there is insufficient evidence to determine if garlic provides a therapeutic advantage versus placebo in terms of reducing the risk of mortality and cardiovascular morbidity in patients diagnosed with hypertension. There is also insufficient evidence to determine the difference in withdrawals due to adverse events between patients treated with garlic or placebo. \n\nBased on two trials in 87 hypertensive patients, it appears that garlic reduces mean supine systolic and DBP by approximately 10‐12 mm Hg and 6‐9 mm Hg, respectively, over and above the effect of placebo but the confidence intervals for these effect estimates are not precise and this difference in blood pressure reduction falls within the known variability in blood pressure measurements. This makes it difficult to determine the true impact of garlic on lowering blood pressure. \n"]
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[null,"de Jongh  T et al. Mobile phone messaging for facilitating self‐management of long‐term illnesses. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD007459. DOI: 10.1002/14651858.CD007459.pub2.\nAvailable here. ","All study participants regardless of age, gender, ethnicity, and type and stage of disease.","This Cochrane review aimed to assess the effects of mobile phone messaging applications designed to facilitate self-management of long-term illnesses on health outcomes and patients' capacity to self-manage their condition. \n\nFour RCTs (reported in seven papers) were included in the review. One of these studies looked at patients with hypertension, and compared systolic and DBP in groups of patients with and without text message support, at baseline and one, three and six months after initiation of the study. Blood pressure levels at six months were comparable in the two groups (SBP MD 1.10, 95% CI ‐4.37 to 6.57); DBP MD 1.84, 95% CI ‐2.14 to 5.82). Achievement of good blood pressure control (as defined by having blood pressure less than 140/90 mm Hg in patients without diabetes and 130/85 mm Hg in patients with diabetes) at the end of the study was not statistically different between the control and intervention groups (RR of not achieving blood pressure control 0.73, 95% CI 0.41 to 1.29). The body weight of the participants at six months was also comparable between groups (MD ‐ 2.76 (95% CI ‐8.17 to 2.65). For all of the reported outcome measures the evidence is considered to be of moderate quality only, due to the small number of patients enrolled in the trial. The observed effect sizes are likely to be affected by further research.\n\n","The authors conclude that there was some very limited indications that in certain cases mobile phone messaging interventions may provide benefit in supporting the self‐management of long‐term illnesses. However, there are significant information gaps regarding the long‐term effects, acceptability, costs, and risks of such interventions. Given the enthusiasm with which so‐called mHealth interventions are currently being implemented, further research into these issues is needed.  "]
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[null,"Harris J, Felix L, Miner A, Murray E, Michie S. Adaptive e-learning to improve dietary behaviour: a systematic review and cost-effectiveness analysis. Health Technology Assessment 2011;15(37)\nAvailable here","Adults","The most commonly used behavioural change techniques reported to have been used were: goal setting; feedback on performance; information on consequences of behaviour in general; barrier identification/problem solving; prompting self-monitoring of behaviour; and instruction on how to perform the behaviour.\n\nThere was substantial heterogeneity in the estimates of effect. E-learning interventions were associated with a WMD of +0.24 (95% CI 0.04 to 0.44) servings of fruit and vegetables per day; -0.78 g (95% CI -2.5 g to 0.95 g) total fat consumed per day; -0.24 g (95% CI -1.44 g to 0.96 g) saturated fat intake per day; -1.4% (95% CI -2.5% to -0.3%) of total energy consumed from fat per day; +1.45 g (95% CI -0.02 g to 2.92 g) dietary fibre per day; +4 kcal (95% CI -85 kcal to 93 kcal) daily energy intake; -0.1 kg/m2 (95% CI -0.7 kg/m2 to 0.4 kg/m2) change in body mass index.\n\nFor blood pressure change as an outcome, the combined summarised result for the two studies focussed on systolic blood pressure was WMD 0.39 (mmHg) ranging between (−3.23 to 4.01) when using 95% CI. For diastolic blood pressure the summarised WMD was -0.30 (mmHg) ranging between (-0.49 to -0.11) when using 95% CI. ","There are many factors affecting what foods people eat and why, and an intervention targeted\nat individual behaviour change can address only a selection of these. E-learning has not yet\nproved itself to be more effective or cost-effective than other behaviour change approaches at an\nindividual level for improving diet, or for preventing or reducing overweight or obesity. Nor is\nthere any research comparing e-learning approaches with population-level approaches to tackling\ndietary change or reducing obesity.\n"]
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[null,"Ebrahim  S et al. Multiple risk factor interventions for primary prevention of coronary heart disease. Cochrane Database of Systematic Reviews 2011, Issue 1. Art. No.: CD001561. DOI: 10.1002/14651858.CD001561.pub3\nAvailable here.","Adult populations with a mean age of 35 or above. General populations could include workforce populations and high risk groups, as well as subjects who did not have a high risk of developing CHD.","This Cochrane review aimed to assess the effects of multiple risk factor interventions for reducing total mortality, fatal and non-fatal events from CHD and cardiovascular risk factors among adults assumed to be without prior clinical evidence of CHD. Types of interventions included health promotion activities to achieve behaviour change. More specifically counselling or educational interventions, with or without pharmacological treatments, that aimed to alter more than one cardiovascular risk factor. \n\nOverall, 55 trials (n=163,471) were included in the review. Blood pressure change was a secondary outcome , the results are reported below:\n\nFor both systolic and DBP, 48 trials (53 arms) indicated a significant reduction favouring intervention. The weighted mean difference between intervention and control was ‐2.71 mm Hg (95% CI ‐3.49 to ‐1.93; n = 64,809) for SBP and ‐2.13 mm Hg (95% CI ‐2.67 to ‐1.58; n = 75,400) for DBP using random‐effects models. In total, 24 trials reported that patients were on medication for high blood pressure. When analysis of outcomes was confined to these trials, strong evidence of reductions in both systolic and diastolic remained. This was also seen when the analysis was confined to trials where no medication was prescribed.\n\nNot all trials reported, or were able to provide data on, blood pressure at follow up. Overall, changes in blood pressure were small. For both outcomes there was no evidence of small study bias in the trials as shown by the funnel plots.\n\n\n","Interventions using counselling and education aimed at behaviour change do not reduce total or CHD mortality or clinical events in general populations but may be effective in reducing mortality in high‐risk hypertensive and diabetic populations. Risk factor declines were modest but owing to marked unexplained heterogeneity between trials, the pooled estimates are of dubious validity. Evidence suggests that health promotion interventions have limited use in general populations. "]
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[null,"Canadian Agency for Drugs and Technologies in Health. Blood pressure monitoring chairs to identify hypertension: a review of the clinical effectiveness and guidelines. Ottawa: CADTH.\nAvailable here.  ","Unspecified.","This CADTH report aimed to review and critically appraise the quality of evidence-based guidelines, health technology assessments, systematic reviews, meta-analyses, and RCTs evaluating the clinical effectiveness of blood pressure monitoring (BPM) chairs, relative to auscultatory and automated methods.\n\nNo relevant health technology assessments, systematic reviews, meta-analyses or RCTs were identified in the literature search. One evidence-based North American guideline discussing a role for BPM chairs in the identification of hypertension was identified.\n\n","Insufficient research has been conducted to validate the clinical effectiveness of BPM chairs for reliably identifying hypertensive patients. Evidence-based clinical guidelines do not incorporate BPM chairs into algorithms for the diagnosis of hypertension, and acknowledge the lack of research towards their validation."]
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[null,"Carr S et al.  An evidence synthesis of qualitative and quantitative research on component intervention techniques, effectiveness, cost-effectiveness, equity and acceptability of different versions of health-related lifestyle advisor role in improving health. Health Technology Assessment 2011; 15(9).\nAvailable here.","General adult population","This review aimed to identify and analyse the range of models developed to date for delivering health-related lifestyle advice (HRLA), or training, for effectiveness and cost-effectiveness in improving the health and well-being of individuals and communities in the UK.\n\nOverall, there was insufficient evidence to either support or refute the use of LAs to promote health and improve quality of life. The economic analysis showed that LA interventions were not cost-effective for diet/physical activity.\n\nFive studies were identified in relation to diet and exercise. Two examined healthy diet promotion alone and three examined the promotion of healthy diet and greater levels of physical activity. Three of the studies assessed a variety of physiological measures, the majority of which did not differ significantly between the groups. However, (Staten 2004) found small but statistically significant reductions in systolic blood pressure. The study (Staten 2004) reported on change in systolic blood pressure in an intervention group with a Community Health Worker versus two other groups that had provider counselling and health education. There were significant reductions in systolic blood pressure in the CHW group (approximately 5.4 mmHg – insufficient information to calculate effect size) versus both other groups (linear regression unadjusted).","Evidence was variable, giving only limited support to LAs having a positive impact on health knowledge, behaviours and outcomes. Levels of acceptability appeared to be high. LAs acted as translational agents, sometimes removing barriers to prescribed behaviour or helping to create facilitative social environments. \n\nReporting of processes of accessing or capitalising on indigenous knowledge was limited. Ambiguity was apparent with respect to the role and impact of lay and peer characteristics of the interventions. \n\nA future programme of research on HRLA could benefit from further emphasis on identification of needs, the broadening of population focus and intervention aims, the measurement of outcomes and the reviewing of evidence."]

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[null,null,null,"Include"]
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[null,"Canllawiau ac adolygiadau systemataidd gyda ffocws sylfaenol ar atal pwysedd gwaed uchel"]
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[null,"Canllaw penodol ar bwysedd gwaed uchel"]
[null,"Ffynhonnell:","Cynulleidfa:","Argymhellion:"]
[null,"BMJ Best Practice. (2019). Essential Hypertension. London: BMJ Publishing Group Ltd. \nAvailable here.\n\nLast updated March 2019.","Medical professionals situated outside of the United States and Canada. ","The BMJ Best Practice summary on essential hypertension includes information on the definition, epidemiology, aetiology and pathophysiology of hypertension, along with information on prevention, diagnosis, treatment and follow-up and details of current diagnostic and treatment guidelines.\n\nIt states that hypertension is typically diagnosed by screening of an asymptomatic individual. Treatment of uncontrolled hypertension reduces the risks of mortality and of cardiac, vascular, renal and cerebrovascular complications. Lifestyle changes are recommended for all patients: weight loss, exercise, decreased sodium intake, dietary approaches to stop hypertension (DASH) and moderation of alcohol consumption. Choice of drug therapy is often driven by considerations related to comorbid disease, but achievement of blood pressure goal may be accomplished with a variety of therapeutic agents. "]
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[null,"Adolygiadau systemataidd"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Graudal NA et al. Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride. Cochrane Database of Systematic Reviews 2020, Issue 12. Art. No.: CD004022. DOI: 10.1002/14651858.CD004022.pub5.\nAvailable here","The authors compared normotensive and hypertensive populations in White, Black and Asian populations; mostly adults some adolescents. ","This update of a 2017 Cochrane review (first published 2003) aimed to assess the effects of sodium reduction on blood pressure, and on potential side‐effects (hormones and lipids). Since the first review in 2003 the number of included references has increased from 96 to 195 (174 were in white participants). As a previous study found different blood pressure outcomes in black and white study populations, the authors stratified the BP outcomes by race.\n\nThe effect of sodium reduction (from 203 to 65 mmol/day) on BP in white participants was as follows: Normal blood pressure: SBP: mean difference (MD) ‐1.14 mmHg (95% confidence interval (CI): ‐1.65 to ‐0.63), 5982 participants, 95 trials; DBP: MD + 0.01 mmHg (95% CI: ‐0.37 to 0.39), 6276 participants, 96 trials. Hypertension: SBP: MD ‐5.71 mmHg (95% CI: ‐6.67 to ‐4.74), 3998 participants,88 trials; DBP: MD ‐2.87 mmHg (95% CI: ‐3.41 to ‐2.32), 4032 participants, 89 trials (all high‐quality evidence).\n\nThe effect of sodium reduction (from 195 to 66 mmol/day) on BP in black participants was as follows: Normal blood pressure: SBP: mean difference (MD) ‐4.02 mmHg (95% CI:‐7.37 to ‐0.68); DBP: MD ‐2.01 mmHg (95% CI:‐4.37, 0.35), 253 participants, 7 trials. Hypertension: SBP: MD ‐6.64 mmHg (95% CI:‐9.00, ‐4.27); DBP: MD ‐2.91 mmHg (95% CI:‐4.52, ‐1.30), 398 participants, 8 trials (low‐quality evidence).\n\nThe effect of sodium reduction (from 217 to 103 mmol/day) on BP in Asian participants was as follows: Normal blood pressure: SBP: mean difference (MD) ‐1.50 mmHg (95% CI: ‐3.09, 0.10); DBP: MD ‐1.06 mmHg (95% CI:‐2.53 to 0.41), 950 participants, 5 trials. Hypertension: SBP: MD ‐7.75 mmHg (95% CI:‐11.44, ‐4.07); DBP: MD ‐2.68 mmHg (95% CI: ‐4.21 to ‐1.15), 254 participants, 8 trials (moderate‐low‐quality evidence).\n","In white participants, sodium reduction in accordance with the public recommendations resulted in mean arterial pressure (MAP) decrease of about 0.4 mmHg in participants with normal blood pressure and a MAP decrease of about 4 mmHg in participants with hypertension. Weak evidence indicated that these effects may be a little greater in black and Asian participants. The effects of sodium reduction on potential side effects (hormones and lipids) were more consistent than the effect on BP, especially in people with normal BP."]
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[null,"Ried  K, Fakler  P, Stocks  NP. Effect of cocoa on blood pressure. Cochrane Database of Systematic Reviews 2017, Issue 4. Art. No.: CD008893. DOI: 10.1002/14651858.CD008893.pub3.\nAvailable here.","Adults (no further restrictions)","This Cochrane review aimed to assess the effects on blood pressure of chocolate or cocoa products versus low‐flavanol products or placebo in adults with or without hypertension when consumed for two weeks or longer.\n\nThirty‐five trials (including 40 treatment comparisons) met the inclusion criteria. Of these, 17 trials were added (20 treatment comparisons) to the 18 trials (20 treatment comparisons) in the previous version of this updated review. \n\nTrials provided participants with 30 to 1218 mg of flavanols (mean = 670 mg) in 1.4 to 105 grams of cocoa products per day in the active intervention group. The control group received either a flavanol‐free product (n = 26 treatment comparisons) or a low‐flavanol‐containing cocoa powder (range 6.4 to 88 mg flavanols (mean = 55 mg, 13 treatment comparisons; 259 mg, one trial). \n\nMeta‐analyses of the 40 treatment comparisons involving 1804 mainly healthy participants revealed a small but statistically significant blood pressure‐reducing effect of flavanol‐rich cocoa products compared with control in trials of two to 18 weeks duration (mean nine weeks): Mean difference SBP (95% confidence interval (CI): ‐1.76 (‐3.09 to ‐0.43) mm Hg, p = 0.009, n = 40 treatment comparisons, 1804 participants; Mean difference DBP (95% CI): ‐1.76 (‐2.57 to ‐0.94) mm Hg, p < 0.001, n = 39 treatment comparisons, 1772 participants. \n\nBaseline blood pressure may play a role in the effect of cocoa on blood pressure. While SBP was reduced significantly by 4 mm Hg in hypertensive people (n = 9 treatment comparisons, 401 participants), and tended to be lowered in prehypertensive people (n= 8 treatment comparisons, 340 participants), there was no significant difference in normotensive people (n = 23 treatment comparisons, 1063 participants); however, the test for subgroup differences was of borderline significance (p = 0.08; I2 = 60%), requiring further research to confirm the findings. \n\n\n","This review provides moderate‐quality evidence that flavanol‐rich chocolate and cocoa products cause a small (2 mm Hg) blood pressure‐lowering effect in mainly healthy adults in the short term. \n\nThese findings are limited by the heterogeneity between trials, which could not be explained by prespecified subgroup analyses, including blinding, flavanol content of the control groups, age of participants, or study duration. However, baseline blood pressure may play a role in the effect of cocoa on blood pressure; subgroup analysis of trials with (pre)hypertensive participants revealed a greater blood pressure‐reducing effect of cocoa compared to normotensive participants with borderline significance. \n\nLong‐term trials investigating the effect of cocoa on clinical outcomes are also needed to assess whether cocoa has an effect on cardiovascular events and to assess potential adverse effects associated with chronic ingestion of cocoa products. \n"]
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[null,"McLaren  L et al. Population‐level interventions in government jurisdictions for dietary sodium reduction. Cochrane Database of Systematic Reviews 2016, Issue 9. Art. No.: CD010166. DOI: 10.1002/14651858.CD010166.pub2\nAvailable here. ","Populations of all ages.","This Cochrane review aimed to assess the impact of population-level interventions for dietary sodium reduction in government jurisdictions worldwide and to assess the differential impact of those initiatives by social and economic indicators. \n\nFifteen national initiatives which included more than 260,000 people met the inclusion criteria for the review. None of the initiatives were in lower middle income or low income countries and all except one used an uncontrolled pre-post study design. \n\nTen initiatives provided sufficient data for quantitative analysis of impact (64,798 participants). Evidence was graded as very low due to the risk of bias of the included studies, as well as variation in the direction and size of effect across the studies. Five of these showed mean decreases in average daily salt intake per person from pre‐intervention to post‐intervention, ranging from 1.15 grams/day less (Finland) to 0.35 grams/day less (Ireland). Two initiatives showed mean increase in salt intake from pre‐intervention to post‐intervention: Canada (1.66) and Switzerland (0.80 grams/day more per person); however in both countries the pre‐intervention data point was from several years prior to the initiation of the intervention. The remaining initiatives did not show a statistically significant mean change. \n\nSeven of the 10 initiatives were multi‐component and incorporated intervention activities of a structural nature (e.g. food product reformulation, food procurement policy in specific settings). Of those seven initiatives, four showed a statistically significant mean decrease in salt intake from pre‐intervention to post‐intervention, ranging from Finland to Ireland (see above), and one showed a statistically significant mean increase in salt intake from pre‐intervention to post‐intervention (Switzerland; see above). \n\nMany studies had methodological strengths, including large, nationally representative samples of the population and rigorous measurement of dietary sodium intake. However, all studies were scored as having high risk of bias, reflecting the observational nature of the research and the use of an uncontrolled study design. The quality of evidence for the main outcome was low. \n\n\n\n\n","Population‐level interventions in government jurisdictions for dietary sodium reduction have the potential to result in population‐wide reductions in salt intake from pre‐intervention to post‐intervention, particularly if they are multi‐component (more than one intervention activity) and incorporate intervention activities of a structural nature (e.g. food product reformulation) and particularly amongst men. Heterogeneity across studies was significant, reflecting different contexts (population and setting) and initiative characteristics. Implementation of future initiatives should embed more effective means of evaluation to help us better understand the variation in the effects. "]
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[null,"Bloomfield HE et al. Benefits and Harms of the Mediterranean Diet Compared to Other Diets. Minneapolis: Veterans Affairs Evidence-based synthesis program; 2015. \nAvailable here. ","Adults (18+) not pregnant or lactating and not hospitalised or institutionalised. ","This systematic review aimed to assess whether the Mediterranean diet is more effective than other diets in preventing death or the development of type 2 diabetes mellitus, cardiovascular disease, cancer, hypertension, cognitive impairment, or kidney disease. \n\nThe review included 93 papers reporting on 55 studies published between 1990 and 2015. The authors did not find any studies reporting on the Mediterranean diet for preventing or treating hypertension. ","In this systematic review and meta-analysis of 55 published studies we identified a single primary prevention trial which found that consumption of a Mediterranean diet was associated with a significant reduction in major cardiac events, new onset T2DM, and breast cancer incidence. For secondary prevention, data from two trials indicate that assignment to a Mediterranean diet reduces incidence of myocardial infarction but not other cardiovascular outcomes. Cohort studies indicate that conformity to a Mediterranean diet pattern is associated with significant reduction in total cancer incidence, total cancer mortality and colorectal cancer incidence. These associations have not been confirmed in RCTs.  The available data on dietary adherence suggest that sustained increases in consumption of fruits and vegetables and grains can be achieved with labour-intensive behavioral interventions in select populations."]
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[null,"He  FJ et al. Effect of longer‐term modest salt reduction on blood pressure. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD004937. DOI: 10.1002/14651858.CD004937.pub2.\nAvailable here. ","Adults with normal or raised blood pressure. ","This Cochrane review aimed to assess (1) the effect of long-term modest reduction in salt intake on BP and whether there was a dose-response relationship; (2) the effect on BP by sex and ethnic group; (3) the effect on plasma renin activity, aldosterone, noradrenaline, adrenaline, cholesterol, low‐density lipoprotein (LDL), high‐density lipoprotein (HDL) and triglycerides. \n\nThirty‐four trials (3,230 participants) were included. Meta‐analysis showed that the mean change in urinary sodium (reduced salt vs usual salt) was ‐75 mmol/24‐h (equivalent to a reduction of 4.4 g/d salt), the mean change in BP was ‐4.18 mm Hg (95% CI: ‐5.18 to ‐3.18, I2=75%) for systolic and ‐2.06 mm Hg (95% CI: ‐2.67 to ‐1.45, I2=68%) for diastolic BP. Meta‐regression showed that age, ethnic group, BP status (hypertensive or normotensive) and the change in 24‐h urinary sodium were all significantly associated with the fall in systolic BP, explaining 68% of the variance between studies. A 100 mmol reduction in 24 hour urinary sodium (6 g/day salt) was associated with a fall in systolic BP of 5.8 mm Hg (95%CI: 2.5 to 9.2, p=0.001) after adjusting for age, ethnic group and BP status. For diastolic BP, age, ethnic group, BP status and the change in 24‐h urinary sodium explained 41% of the variance between studies. Meta‐analysis by subgroup showed that, in hypertensives, the mean effect was ‐5.39 mm Hg (95% CI: ‐6.62 to ‐4.15, I2=61%) for systolic and ‐2.82 mm Hg (95% CI: ‐3.54 to ‐2.11, I2=52%) for diastolic BP. In normotensives, the mean effect was ‐2.42 mm Hg (95% CI: ‐3.56 to ‐1.29, I2=66%) for systolic and ‐1.00 mm Hg (95% CI: ‐1.85 to ‐0.15, I2=66%) for diastolic BP. Further subgroup analysis showed that the decrease in systolic BP was significant in both whites and blacks, men and women. Meta‐analysis of hormone and lipid data showed that the mean effect was 0.26 ng/ml/hr (95% CI: 0.17 to 0.36, I2=70%) for plasma renin activity, 73.20 pmol/l (95% CI: 44.92 to 101.48, I2=62%) for aldosterone, 31.67 pg/ml (95% CI: 6.57 to 56.77, I2=5%) for noradrenaline, 6.70 pg/ml (95% CI: ‐0.25 to 13.64, I2=12%) for adrenaline, 0.05 mmol/l (95% CI: ‐0.02 to 0.11, I2=0%) for cholesterol, 0.05 mmol/l (95% CI: ‐0.01 to 0.12, I2=0%) for LDL, ‐0.02 mmol/l (95% CI: ‐0.06 to 0.01, I2=16%) for HDL, and 0.04 mmol/l (95% CI: ‐0.02 to 0.09, I2=0%) for triglycerides.","A modest reduction in salt intake for four or more weeks causes significant and, from a population viewpoint, important falls in BP in both hypertensive and normotensive individuals, irrespective of sex and ethnic group. With salt reduction, there is a small physiological increase in plasma renin activity, aldosterone and noradrenaline. There is no significant change in lipid levels. These results provide further strong support for a reduction in population salt intake. This will likely lower population BP and, thereby, reduce cardiovascular disease. Additionally, our analysis demonstrates a significant association between the reduction in 24‐h urinary sodium and the fall in systolic BP, indicating the greater the reduction in salt intake, the greater the fall in systolic BP. The current recommendations to reduce salt intake from 9‐12 to 5‐6 g/d will have a major effect on BP, but are not ideal. A further reduction to 3 g/d will have a greater effect and should become the long term target for population salt intake."]
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[null,"Usinger  L et al. Fermented milk for hypertension. Cochrane Database of Systematic Reviews 2012, Issue 4. Art. No.: CD008118. DOI: 10.1002/14651858.CD008118.pub2.\nAvailable here. ","Adults (age 18+).","This Cochrane review investigated whether fermented milk or similar products produced by lactobacilli fermentation of milk proteins have any blood pressure lowering effect in humans when compared to no treatment or placebo. \n\nFifteen studies were included in the review. The studies were all placebo-controlled and four studies used a cross over design. The length of studies varied from four to 23 weeks with intervention periods of  four to 21 weeks. Most studies were double-blind, but three were single-blind. One study consisted of two different arms where one received a fermented milk with added potassium and the other arm a similar fermented milk without added potassium. Another study had separate intervention groups according to the participants' baseline BP. A further study had three different intervention groups: lactotripeptides (LTP) produced synthetic, enzymatic hydrolysis and bacterial fermentation. Finally, two studies had several intervention groups with different concentration levels of the active product. \n\nAll studies, except one, had industry funding and/or some or all of the authors were employed by private food companies. Similarly in all these studies the test and placebo products were produced by the involved companies. \n\nAn overall effect was found on office SBP (MD ‐2.45; 95% CI ‐4.30, ‐0.60; n=1,232; 15 studies), but no effect on DBP (MD ‐0.67; 95% CI ‐1.48, 0.14; n=1,232; 15 studies). The length of the intervention (more than 8 weeks compared to 4‐8 weeks) did not influence the effect on BP.  After removing the eight studies with high risk of bias significant effects were seen as a result of the intervention on neither SBP (MD ‐0.57 mm Hg; 95% CI ‐3.12 to 1.98) nor DBP (MD ‐0.39 mm Hg; 95% CI ‐1.78 to 1.01). \n","The authors conclude that the review does not support an effect of fermented milk on blood pressure. Despite the positive effect on SBP the authors conclude, for several reasons, that fermented milk has no effect on blood pressure. The effect found was very modest and only on SBP, the included studies were very heterogeneous and several with weak methodology. Finally, sensitivity and subgroup analyses could not reproduce the antihypertensive effect. The results do not support the use of fermented milk as treatment for hypertension or as a lifestyle intervention for pre‐hypertension nor would it influence population blood pressure. "]
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[null,"Canllawiau ac adolygiadau systemataidd  gyda ffocws sylfaenol ar atal clefydau cardiofasgwlaidd,  ond sy’n cynnwys canlyniadau pwysedd gwaed uchel ac sy’n cynnwys o leiaf rhai astudiaethau o boblogaethau heb bwysedd gwaed uchel"]
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[null,"Canllaw ehangach ar atal ffactorau risg ar gyfer pwysedd gwaed uchel:"]
[null,"Ffynhonnell:","Cynulleidfa:","Argymhellion:"]
[null,"National Institute for Health and Care Excellence. Cardiovascular disease prevention PH25. London: NICE, 2010.\nAvailable here. \n\nUnderpinning evidence reviews:\n\nNational Institute for Health and Care Excellence. Prevention of cardiovascular disease. Evidence update January 2014. London: NICE, 2014. \nAvailable here. ","This guideline is for national government, NHS and local authorities, industry, commissioners, managers and practitioners working in the above and in the wider public, private, voluntary and community sections, and members of the public. ","This guideline covers the main risk factors linked with CVD:  poor diet, physical inactivity, smoking and excessive alcohol consumption. It aims to reduce the high incidence of CVD. This, in turn, will help prevent other major causes of death and illness, such as type 2 diabetes and many cancers.\n\nThis guideline includes recommendations for policy: a national framework for action and recommendations for practice. Topics covered include:\n\n - How to reduce the nation’s consumption of salt, saturated fats and trans fats\n - Commercial interests\n - Product labelling\n - Public sector catering guidelines\n - Regional CVD prevention programmes\n - Health impact assessments of regional and local plans and policies\n - Take-aways and other food outlets\n\nThe guidance is intended to complement other NICE guidance, including guidance on hypertension.\n\nIn the underpinning evidence review update, one key point states that \"Local policies to reduce intake of salt from foods provided by the public sector might result in fewer cases of hypertension, and corresponding decreases in direct healthcare costs\". It states that \"reducing UK salt intake by 3g/day might prevent approximately 10,000 deaths and 10,000 non-fatal cardiovascular events each year. This would exceed benefits from smoking cessation programmes, weight loss interventions in individuals, and statins. Reduction in salt intake by as little as 1 g/day may be more cost effective than blood pressure-lowering drugs\". \n\nThe underpinning review update also states that \"sugar-sweetened drinks may be associated with an increased risk of incident hypertension, though causality is uncertain. Evidence that artificially sweetened drinks might also be associated with hypertension is conflicting\", however this is not covered within the guideline. "]
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[null,"Adolygiadau systemataidd"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Rees K et al. Vegan dietary pattern for the primary and secondary prevention of cardiovascular diseases. Cochrane Database of Systematic Reviews 2021, Issue 2. Art. No.: CD013501.\nAvailable here","Adults (≥ 18 years of age) from the general population and those at high risk of CVD to examine primary prevention, and those with established CVD to examine secondary prevention.","The authors included thirteen RCTs (38 papers, 7 trial registrations) and eight ongoing trials. \nThe authors conducted three main comparisons:\n1. Vegan dietary intervention versus no intervention or minimal intervention for primary prevention; 2. Vegan dietary intervention versus another dietary intervention for primary prevention; \n3. Vegan dietary intervention versus another dietary intervention for secondary prevention.\nMost trials contributed to primary prevention: comparisons 1 (four trials, 466 participants randomised) and comparison 2 (eight trials, 409 participants randomised). They included only one secondary prevention trial for comparison 3 (63 participants randomised).\nFor comparison 1, there was a lack of evidence for an effect with the vegan dietary intervention on systolic blood pressure (MD 0.94 mmHg, 95% CI −1.18 to 3.06; 3 trials, 374 participants) and diastolic blood pressure (MD−0.27 mmHg, 95% CI −1.67 to 1.12; 3 trials, 372 participants) (low-certainty evidence).\nFor comparison 2 the authors are very uncertain about any effect of the vegan dietary intervention on systolic blood pressure (MD 0.02 mmHg, 95% CI −3.59 to 3.62) or diastolic blood pressure (MD 0.63 mmHg, 95% CI −1.54 to 2.80; 5 trials,247 participants (very low-certainty evidence)).\nOnly one trial (63 participants) contributed to comparison 3, where there was a lack of evidence for an effect of the vegan dietary intervention on lipid levels or blood pressure compared to other dietary interventions (low- or very low-certainty evidence).","Studies were generally small with few participants contributing to each comparison group. None of the included studies report on CVD clinical events. There is currently insufficient information to draw conclusions about the effects of vegan dietary interventions on CVD risk factors. The eight ongoing studies identified will add to the evidence base, with all eight reporting on primary prevention. There is a paucity of evidence for secondary prevention."]
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[null,"Palmer MJ et al. Mobile phone-based interventions for improving adherence to medication prescribed for the primary prevention of cardiovascular disease in adults. Cochrane Database of Systematic Reviews 2021, Issue 3. Art. No.: CD012675.\nAvailable here","Adults (aged 18 years and over) who have been prescribed medication for the primary prevention of CVD.","The authors included 14 trials with 25,633 randomised participants. Participants were from community-based primary and tertiary care or outpatient clinics. The interventions varied from short messaging service (SMS) to those involving a combination of modes of delivery, such as SMS in addition to healthcare worker training, face-to-face counselling, electronic pillboxes, written materials, and home blood pressure monitors. Some interventions only targeted medication adherence, while others additionally targeted lifestyle changes such as diet and exercise.\n\nAcross 13 studies (25,166 participants) measuring systolic blood pressure, effect estimates ranged from a large reduction (MD −12.45 mmHg,95% CI−15.02 to −9.88) to a small increase (MD 2.80 mmHg, 95% CI 0.30 to 5.30). The authors found a similar range of effect estimates for diastolic BP, ranging from −12.23 mmHg (95% CI −14.03 to −10.43) to 1.64 mmHg (95% CI −0.55 to 3.83) (11 trials, 19,716 participants). Four trials showed intervention benefits for systolic and diastolic BP with confidence intervals excluding no effect, and among these were all three of the trials evaluating self-monitoring of blood pressure with mobile phone-based telemedicine. Pooled analyses of the two trials of interventions solely delivered through SMS were indicative of little or no beneficial intervention effect on systolic BP (MD −1.55 mmHg, 95% CI −3.36 to 0.25; I2 = 0%) and small increases in controlled BP (OR 1.32, 95% CI 1.06 to 1.65; I2 = 0%).","There is low-certainty evidence on the effects of mobile phone-delivered interventions to increase adherence to medication prescribed for the primary prevention of CVD. Trials of BP self-monitoring with mobile-phone telemedicine support reported modest benefits. One trial at low risk of bias reported modest reductions in LDL cholesterol but no benefits for BP. There is moderate-certainty evidence that these interventions do not result in harm. Further trials of these interventions are warranted."]
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[null,"Hooper  L, et al. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database of Systematic Reviews 2020, Issue 8. Art. No.: CD011737. DOI: 10.1002/14651858.CD011737.pub3. Available here.","Adults (18 years or older), with and without cardiovascular disease.","The authors sought to assess the effect of reducing saturated fat intake and replacing it with carbohydrate (CHO), polyunsaturated (PUFA), monounsaturated fat (MUFA) and/or protein on mortality and cardiovascular morbidity.\nThey included trials that used a variety of interventions from providing all food to advice on reducing saturated fat. The included long‐term trials suggested that reducing dietary saturated fat reduced the risk of combined cardiovascular events by 17% (risk ratio (RR) 0.83; 95% confidence interval (CI) 0.70 to 0.98, 12 trials, 53,758 participants of whom 8% had a cardiovascular event, I² = 67%, GRADE moderate‐quality evidence). Meta‐regression suggested that greater reductions in saturated fat (reflected in greater reductions in serum cholesterol) resulted in greater reductions in risk of CVD events, explaining most heterogeneity between trials. The number needed to treat for an additional beneficial outcome (NNTB) was 56 in primary prevention trials, so 56 people need to reduce their saturated fat intake for four years for one person to avoid experiencing a CVD event. In secondary prevention trials, the NNTB was 53. Subgrouping did not suggest significant differences between replacement of saturated fat calories with polyunsaturated fat or carbohydrate, and data on replacement with monounsaturated fat and protein was very limited. \n\nThe authors found little or no effect of reducing saturated fat on all‐cause mortality (RR 0.96; 95% CI 0.90 to 1.03; 11 trials, 55,858 participants) or cardiovascular mortality (RR 0.95; 95% CI 0.80 to 1.12, 10 trials, 53,421 participants), both with GRADE moderate‐quality evidence. \n\nThere was little or no effect of reducing saturated fats on non‐fatal myocardial infarction (RR 0.97, 95% CI 0.87 to 1.07) or CHD mortality (RR 0.97, 95% CI 0.82 to 1.16, both low‐quality evidence), but effects on total (fatal or non‐fatal) myocardial infarction, stroke and CHD events (fatal or non‐fatal) were all unclear as the evidence was of very low quality. There was little or no effect on cancer mortality, cancer diagnoses, diabetes diagnosis, HDL cholesterol, serum triglycerides or blood pressure, and small reductions in weight, serum total cholesterol, LDL cholesterol and BMI. There was no evidence of harmful effects of reducing saturated fat intakes.","The findings of this updated review suggest that reducing saturated fat intake for at least two years causes a potentially important reduction in combined cardiovascular events. Replacing the energy from saturated fat with polyunsaturated fat or carbohydrate appear to be useful strategies, while effects of replacement with monounsaturated fat are unclear. \nThe reduction in combined cardiovascular events resulting from reducing saturated fat did not alter by study duration, sex or baseline level of cardiovascular risk, but greater reduction in saturated fat caused greater reductions in cardiovascular events."]
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[null,"Clar  C et al. Low glycaemic index diets for the prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2017, Issue 7. Art. No.: CD004467. DOI: 10.1002/14651858.CD004467.pub3.\nAvailable here. ","Adults who were either healthy, had established cardiovascular disease, or one or more of the following risk factors: abnormal blood lipid levels (high and low density lipoprotein (HDL, LDL) cholesterol, triglycerides and total cholesterol), raised blood pressure/hypertension, overweight (body mass index (BMI) > 25 kg/m2), or obesity (BMI > 30 kg/m2).","This Cochrane review aimed to assess the effect of the dietary glycemic index (GI) on total mortality, cardiovascular events, and cardiovascular risk factors (blood lipids, blood pressure) in healthy people or people who have established cardiovascular disease or related risk factors, using all eligible RCTs.\n\nTwenty‐one RCTs were included, with a total of 2538 participants randomised to low GI intervention (1288) or high GI (1250). All 21 included studies reported the effect of low GI diets on risk factors for cardiovascular disease, including blood lipids and blood pressure. Blood pressure change was a secondary outcome and the results are reported below: \n\nPrimary prevention:\n\nEleven studies reported blood pressure and nine of these could be summarised in a meta‐analysis (10 comparisons). Including all studies reporting this outcome, the change in SBP from baseline to study end varied between ‐10 and +4.5 mm Hg (mean ‐3.44 mm Hg) in the low GI groups and between ‐14 and +5.1 mm Hg (mean ‐4.14 mm Hg) in the control groups. The change in DBP from baseline to study end varied between ‐8 and +1.9 mm Hg (mean ‐1.85 mm Hg) in the low GI groups and between ‐8 and +3.6 mm Hg (mean ‐2.37 mm Hg) in the control groups.\n\nThe pooled analysis showed no evidence of a difference between comparison groups in SBP (MD 0.52 mm Hg, 95% CI ‐1.21 to 2.25, p = 0.55, 786 participants, nine studies, 10 comparisons) with no substantial heterogeneity (I2 = 7%). The pooled analysis showed no evidence of a difference between comparison groups in DBP (MD ‐0.23 mm Hg, 95% CI ‐1.42 to 0.96, p = 0.71, 786 participants, nine studies, 10 comparisons) where there was moderate heterogeneity (I2 = 38%). No evidence of an effect of the magnitude of the difference in GI between comparison diets, of study duration or of weight loss versus weight maintenance studies could be seen.\n\nOf the trials that could not be included in the pooled analysis, the RISCK trial did not show evidence of a difference in systolic or DBP between the low and high GI groups after 24 weeks of intervention. Similarly, there was no evidence of a difference in systolic or DBP between the low and high GI groups after one year in a subgroup of participants of the DiOGenes trial and no evidence of a difference in DBP after four months of intervention in one futher trial.\n\nSecondary Prevention:\n\nIn the one study including participants with CHD, there was no evidence of any differences seen between groups in SBP (MD ‐2.00 mm Hg, 95% CI ‐14.97 to 10.97, 55 participants, one study, one comparison) and DBP (MD ‐4.00 mm Hg, 95% CI ‐13.41 to 5.41).\n\n","There is currently no evidence available regarding the effect of low GI diets on cardiovascular disease events. Moreover, there is currently no convincing evidence that low GI diets have a clear beneficial effect on blood lipids or blood pressure parameters."]
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[null,"Kelly SAM et al. Whole grain cereals for the primary or secondary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2017, Issue 8. Art. No.: CD005051. DOI: 10.1002/14651858.CD005051.pub3.\nAvailable here.","Healthy adults, those at increased risk of CVD, or those who have been previously diagnosed with CVD. ","The aim of this systematic review was to assess the effect of whole grain foods or diets on total mortality, cardiovascular events, and cardiovascular risk factors (blood lipids, blood pressure) in healthy people or people who have established cardiovascular disease or related risk factors, using all eligible RCTs.\n\nNine RCTs randomising a total of 1414 participants (age range 24 to 70; mean age 45 to 59, where reported) to whole grain versus lower whole grain or refined grain control groups were included. Blood pressure change was a secondary outcome in this review and the results are reported below:\n\nEight studies reported SBP and data from seven studies (eight comparators) could be summarised in a meta‐analysis. The pooled analysis showed no effect on SBP (MD 0.04, 95% CI ‐1.67 to 1.75; 768 participants). There was no substantial heterogeneity. In the study that could not be included in the meta‐analysis, there were no effects of whole grain foods compared with the control group. \n\nEight studies reported DBP, and data from seven studies (eight comparators) could be summarised in a meta‐analysis. The pooled analysis showed no effect on DBP (MD 0.16, 95% CI ‐0.89 to 1.21; 768 participants). There was no heterogeneity. In the study that could not be included in the meta‐analysis, there were no effects of whole grain foods compared with the control group. \n\n\n\n","There is insufficient evidence from RCTs of an effect of whole grain diets on cardiovascular outcomes or on major CVD risk factors such as blood lipids and blood pressure. Trials were at unclear or high risk of bias with small sample sizes and relatively short‐term interventions, and the overall quality of the evidence was low. There is a need for well‐designed, adequately powered RCTs with longer durations assessing cardiovascular events as well as cardiovascular risk factors. "]
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[null,"Hartley  L et al. Dietary fibre for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2016, Issue 1. Art. No.: CD011472. DOI: 10.1002/14651858.CD011472.pub2.\nAvailable here. ","Adults at risk of CVD or those from the general population","This Cochrane review aimed to determine the effectiveness of dietary fibre for the primary prevention of CVD. \n\nTwenty-three RCTs (1513 participants randomised) were included in the full review.  The risk of bias was unclear for most studies and studies had small sample sizes. Few studies had an intervention duration of longer than 12 weeks. There was a wide variety of fibre sources used, with little similarity between groups in the choice of intervention.  Change in blood pressure was a secondary outcome of the review, the results are reported below:\n\nEight studies reported SBP and could be summarised in a meta‐analysis (10 comparisons). The pooled analysis showed a reduction in SBP with the intervention but this did not reach statistical significance (MD ‐1.92 mm Hg, 95% CI ‐4.02 to 0.19; p = 0.07). There was significant heterogeneity (p = 0.0006; I2 = 69%) and results were pooled with a random‐effects model. \n\nEight studies reported DBP and could be summarised in a meta‐analysis (10 comparisons). The pooled analysis showed a significant difference between comparison groups favouring fibre (MD ‐1.77 mm Hg, 95% CI ‐2.61 to ‐0.92; p < 0.0001). There was no significant heterogeneity (P = 0.37; I2 = 7%). ","Studies were short term and therefore did not report on the primary outcomes for the review, CVD clinical events. The pooled analyses for CVD risk factors suggest reductions in total cholesterol and LDL cholesterol with increased fibre intake, and reductions in DBP. There authors found no obvious effects of subgroup analyses by type of intervention or fibre type but the number of studies included in each of these analyses were small. Risk of bias was unclear in the majority of studies and high for some quality domains so results need to be interpreted cautiously. The review authors state that there is a need for longer term, well‐conducted RCTs to determine the effects of fibre type (soluble versus insoluble) and administration (supplements versus foods) on CVD events and risk factors for the primary prevention of CVD. "]
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[null,"Hartley  L et al. Vitamin K for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD011148. DOI: 10.1002/14651858.CD011148.pub2.\nAvailable here. ","Healthy adults or adults at high risk of cardiovascular disease. ","This Cochrane review aimed to determine the effectiveness of vitamin K supplementation as a single nutrient supplement for the primary prevention of cardiovascular disease. \n\nOnly one small trial (60 participants randomised) was included in the review, which overall was judged to be at low risk of bias. The study examined two doses of menaquinone (vitamin K2) over three months in healthy participants aged 40 to 65 years. The primary focus of the trial was to examine the effects of menaquinone (subtype MK7) on different matrix Gla proteins (MGP ‐ vitamin K dependent proteins in the vessel wall) at different doses, but the study authors also reported blood pressure and lipid levels. The trial did not report on review primary outcomes (cardiovascular disease clinical events) as it was small, short term and conducted in healthy participants. \n\nIn terms of cardiovascular disease risk factors, no effects were seen for vitamin K2 on blood pressure or lipid levels, although the trial was small and findings are limited. The trial did not report any of the other secondary outcomes for this review. \n","The very limited results of this review highlight the lack of evidence currently available to determine the effectiveness of vitamin K supplementation for the primary prevention of cardiovascular disease and demonstrate the need for further high quality trials in this area. "]
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[null,"Hartley  L et al. Qigong for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2015, Issue 6. Art. No.: CD010390. DOI: 10.1002/14651858.CD010390.pub2.\nAvailable here. ","Healthy adults or adults at high risk of CVD. ","This Cochrane review aimed to determine the effectiveness of qigong for the primary prevention of CVD. Qigong involves physical exercise, mind regulation and breating control to restore the flow of Qi (a pivotal life energy). It is hypothesised that qigong can help to relieve stress and therefore may be effective in the primary prevention of CVD. \n\nThe review authors identified 11 completed trials (1369 participants) and one ongoing trial. Trials were heterogeneous in participants recruited, qigong duration and length of follow‐up periods. The review authors were unable to ascertain the risk of bias in nine trials published in Chinese, as insufficient methodological details were reported and they were unable to contact the study authors to clarify this. \n\nThe review authors did not perform a meta‐analyses, as trials were small and were at significant risk of bias. Clinical events were detailed in subsequent reports of two trials when statistically significant effects of qigong were seen for all‐cause mortality, stroke mortality and stroke incidence at 20 to 30 years after completion of the trials. However, these trials were designed to examine outcomes in the short term and it is not clear whether qigong was practised during extended periods of follow‐up; therefore effects cannot be attributed to the intervention. None of the included studies reported other non‐fatal CVD events. \n\nSix trials provided data that could be used to examine the effects of qigong on blood pressure. Reductions in SBP and DBP were seen in three and two trials, respectively. Three trials examined the effects of qigong on blood lipids when favourable effects were seen in one trial for total cholesterol, low‐density lipoprotein cholesterol and triglycerides and two trials showed favourable effects on high‐density lipoprotein cholesterol. The only trial considered at low risk of selection and detection bias did not demonstrate statistically significant effects on CVD risk factors with qigong, but this study was small and was underpowered. None of the included studies reported incidence of type 2 diabetes, adverse events, quality of life or costs. \n","Currently, very limited evidence is available on the effectiveness of qigong for the primary prevention of CVD. Most of the trials included in this review are likely to be at high risk of bias, so we have very low confidence in the validity of the results. Publication of the ongoing trial will add to the limited evidence base, but further trials of high methodological quality with sufficient sample size and follow‐up are needed to be incorporated in an update of this review before the effectiveness of qigong for CVD prevention can be established."]
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[null,"Hartley  L et al. Tai chi for primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2014, Issue 4. Art. No.: CD010366. DOI: 10.1002/14651858.CD010366.pub2.\nAvailable here.","Healthy adults or adults at high risk of CVD. ","This Cochrane review attempted to determine the effectiveness of tai chi for the primary prevention of CVD. \n\nThirteen small trials were identified (1,520 participants randomised) and three ongoing trials. All studies had at least one domain with unclear risk of bias, and some studies were at high risk of bias for allocation concealment (one study) and selective reporting (two studies). Duration and style of tai chi differed between trials. Seven studies recruited 903 healthy participants, the other studies recruited people with borderline hypertension or hypertension, elderly people at high risk of falling, and people with hypertension with liver and kidney yin deficiency syndrome.\n\nNo studies reported on cardiovascular mortality, all‐cause mortality or non‐fatal events as most studies were short term (all studies had follow‐up of one year or less). There was also considerable heterogeneity between studies, which meant that it was not possible to combine studies statistically for cardiovascular risk (I2 statistic for SBP was 96%, for DBP 96%, for total cholesterol 96%, low‐density lipoprotein‐cholesterol 95%, high‐density lipoprotein‐cholesterol 98%, triglycerides 75%). Nine trials measured blood pressure, six individual trials found reductions in SBP (reductions ranged from ‐22.0 mm Hg (95% confidence interval (CI) ‐26.3 to ‐17.7) to ‐11.5 mm Hg (95% CI ‐21.5 to ‐1.46)), two trials found no clear evidence of a difference (however, CIs were wide and an increase or decrease in SBP cannot be ruled out) and one trial found an increase in SBP with tai chi (increase 5.2 mm Hg, 95% CI 3.73 to 6.67). A similar pattern was seen for DBP: three trials found a reduction in DBP (reductions ranged from ‐12.2 mm Hg (95% CI ‐15.8 to ‐8.7) to ‐4.43 mm Hg (95% CI ‐7.14 to ‐1.72)) and three trials found no clear evidence of a difference, however again with wide CIs. ","There are currently no long‐term trials examining tai chi for the primary prevention of CVD. Due to the limited evidence available currently no conclusions can be drawn as to the effectiveness of tai chi on CVD risk factors. There was some suggestion of beneficial effects of tai chi on CVD risk factors but this was not consistent across all studies. There was considerable heterogeneity between the studies included in this review and studies were small and at some risk of bias. Results of the ongoing trials will add to the evidence base but additional longer‐term, high‐quality trials are needed."]
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[null,"Hartley  L, et al. Yoga for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2014, Issue 5. Art. No.: CD010072. DOI: 10.1002/14651858.CD010072.pub2.\nAvailable here. ","Healthy adults or those at high risk of CVD. ","This Cochrane review aimed to determine the effect of any type of yoga on the primary prevention fo CVD. \n\nEleven trials were identified (800 participants) and two ongoing studies. Style and duration of yoga differed between trials. Half of the participants recruited to the studies were at high risk of CVD. Most of studies were at risk of performance bias, with inadequate details reported in many of them to judge the risk of selection bias.  \n\nNo study reported cardiovascular mortality, all‐cause mortality or non‐fatal events, and most studies were small and short‐term. Blood pressure was a secondary outcome in the review and the results are reported below: \n\nNine of the 11 included studies measured blood pressure. Useable data for meta‐analysis were not available for one study, as no data for the control group were provided, only changes since baseline for the yoga group. In this study, SBP was significantly reduced by yoga (mean difference (MD) ‐5.71 mm Hg, p < 0.01) and DBP was also reduced but this did not reach statistical significance (mean difference ‐3.71 mm Hg, p reported to be non‐significant). The other eight studies could not be combined as there was substantial heterogeneity between trials (I2 = 81%) (485 participants). Two studies showed a significant reduction in SBP with the intervention, and six studies showed yoga to reduce SBP but this did not reach statistical significance. The remaining study showed a significant increase in SBP (MD 2.20, 95% confidence interval (CI) 0.16 to 4.24).\n\nFor DBP (444 participants), we found moderate heterogeneity between studies (I2 = 58%) so we performed a random‐effects meta‐analysis. From the pooled analysis, yoga was found to significantly lower DBP (MD ‐2.90, 95% CI ‐4.52 to ‐1.28). Results were similar for the fixed‐effect model but review authors reported the random‐effects results as the effect estimate is more conservative with wider confidence intervals. Sensitivity analysis, removing studies with high risk of bias based on incomplete outcome data (those with loss to follow‐up of more than 20% without intention‐to‐treat analysis), retained seven studies and statistical significance (MD ‐3.38 mm Hg, 95% CI ‐4.88 to ‐1.88).\n ","The limited evidence comes from small, short‐term, low‐quality studies. There is some evidence that yoga has favourable effects on DBP, HDL cholesterol and triglycerides, and uncertain effects on LDL cholesterol. These results should be considered as exploratory and interpreted with caution."]
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[null,null," ",null,"\n "]
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[null,"Hartley  L et al. Green and black tea for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD009934. DOI: 10.1002/14651858.CD009934.pub2.\nAvailable here. ","Healthy adults or those at high risk of CVD. ","This Cochrane review aimed to determine the effects of green and black tea on the primary prevention of CVD. \n\nEleven RCTs (821 participants), two trials awaiting classification and one ongoing trial were identified. Seven trials examined a green tea intervention and four examined a black tea intervention. Dosage and form of both green and black tea differed between trials. The ongoing trial is examining the effects of green tea powder capsules. Blood pressure was a secondary outcome of the review, the results are reported below:\n\nBlack tea:\nTwo trials examined the effect of black tea on blood pressure. The meta‐analysis (123 participants) showed a statistically significant reduction in SBP (MD ‐1.85 mm Hg, 95% CI ‐3.21 to ‐0.48). DBP (123 participants) was also reduced with the black tea intervention, however, this result did not reach statistical significance (MD ‐1.27 mm Hg, 95% CI ‐3.06 to 0.53). \n\nGreen tea:\nThree trials examining green tea measured blood pressure but one did not provide any individual group data and could not be included in a meta‐analysis. The pooled analysis showed a statistically significant reduction in SBP (167 participants) (MD ‐3.18 mm Hg, 95% CI ‐5.25 to ‐1.11) and DBP (167 participants) (MD ‐3.42, 95% CI ‐4.54 to ‐2.30) in the green tea group. The trial not included in the meta‐analysis showed no significant change in blood pressure in either the tea (SBP change 1.10%, DBP change ‐7.20%) or control group (SBP decrease 0%, DBP decrease 1.10%). \n\nAll tea (green and black):\nFive trials (three using green tea and two using black tea) measured blood pressure. Only four of these contributed to the meta‐analysis as one trial did not report individual group data. The meta‐analysis showed a statistically significant reduction in SBP (290 participants) (MD ‐2.25 mm Hg, 95% CI ‐3.39 to ‐1.11) and DBP (290 participants) (MD ‐2.81 mm Hg, 95% CI ‐3.77 to ‐1.86) with the tea intervention. ","There are very few long‐term studies to date examining green or black tea for the primary prevention of CVD. The limited evidence suggests that tea has favourable effects on CVD risk factors, but due to the small number of trials contributing to each analysis the results should be treated with some caution and further high quality trials with longer‐term follow‐up are needed to confirm this. "]
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[null,"Hartley  L et al. Increased consumption of fruit and vegetables for the primary prevention of cardiovascular diseases. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD009874. DOI: 10.1002/14651858.CD009874.pub2.\nAvailable here. ","Healthy adults or those at high risk of CVD. ","This Cochrane review aimed to determine the effectiveness of 1) advice to increase fruit and vegetable consumption and 2) the provision of fruit and vegetables to increase consumption, for the primary prevention of CVD.\n\nTen trials (n=1,730) and one ongoing trial were identified. Six trials investigated the provision of fruit and vegetables and four trials examined advice to increase fruit and vegetable consumption. The ongoing trial is examining the provision of an avocado‐rich diet. The number and type of intervention components for provision and the dietary advice provided differed between trials.  Change in BP was a secondary outcome of the review, the results are described below:\n\nTwo of the four studies that examined dietary advice to increase the consumption of fruit and vegetables measured blood pressure. In one study, this was at six months and in the other study at 12 months. From the pooled analysis, advice to eat fruit and vegetables significantly reduced SBP (mean difference (MD) ‐3.0 mm Hg (95% confidence interval (CI) ‐4.92 to ‐1.09; 891 participants) but the reduction in DBP was not statistically significant (MD ‐0.90 mm Hg (95% CI ‐2.03 to 0.24; 891 participants). No heterogeneity was found between trials (I2 = 0%).  \n\nFour of the five studies that examined the provision of fruit and vegetables to increase consumption measured blood pressure. One reported medians and interquartile ranges suggesting the data were skewed, and authors of two studies were contacted for information on mean changes and variance but this was not forthcoming. Two studies also did not provide information on effect size or statistical significance.\n\nDifferences were seen for diastolic blood pressure in women with metabolic syndrome in both the intervention and control group (P < 0.05). (30 participants) at 90 days. One study reported no effects on systolic (MD 1.00 mmHg, 95% CI 0.45 to 1.55) (Analysis 2.1) or diastolic blood pressure (MD 1.50 mmHg, 95% CI 1.18 to 1.82) (Analysis 2.2) with the provision of fruit and vegetables to increase consumption (157 participants) at three months. The remaining two studies also reported no effects on blood pressure with the provision of fruit and vegetables to increase consumption (180 participants) at three months and six months. \n","There are very few studies to date examining provision of, or advice to increase the consumption of, fruit and vegetables in the absence of additional dietary interventions or other lifestyle interventions for the primary prevention of CVD. The limited evidence suggests advice to increase fruit and vegetables as a single intervention has favourable effects on CVD risk factors but more trials are needed to confirm this. "]
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[null,"Rees  K et al. Dietary advice for reducing cardiovascular risk. Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.: CD002128. DOI: 10.1002/14651858.CD002128.pub5.\nAvailable here. ","Healthy adults","This Cochrane review aimed to assess the effects of providing dietary advice to achieve sustained dietary changes or improved cardiovascular risk profile among healthy adults.\n\nForty‐four trials with 52 intervention arms (comparisons) comparing dietary advice with no advice were included in the review; 18,175 participants or clusters were randomised. Twenty‐nine of the 44 included trials were conducted in the USA. Dietary advice reduced total serum cholesterol by 0.15 mmol/L (95% CI 0.06 to 0.23) and LDL cholesterol by 0.16 mmol/L (95% CI 0.08 to 0.24) after three to 24 months. Mean HDL cholesterol levels and triglyceride levels were unchanged. Dietary advice reduced blood pressure by 2.61 mm Hg systolic (95% CI 1.31 to 3.91) and 1.45 mm Hg diastolic (95% CI 0.68 to 2.22) and 24‐hour urinary sodium excretion by 40.9 mmol (95% CI 25.3 to 56.5) after three to 36 months but there was heterogeneity between trials for the latter outcome. Three trials reported plasma antioxidants, where small increases were seen in lutein and β‐cryptoxanthin, but there was heterogeneity in the trial effects. Self‐reported dietary intake may be subject to reporting bias and there was significant heterogeneity in all the following analyses. Compared to no advice, dietary advice increased fruit and vegetable intake by 1.18 servings/day (95% CI 0.65 to 1.71). Dietary fibre intake increased with advice by 6.5 g/day (95% CI 2.2 to 10.82), while total dietary fat as a percentage of total energy intake fell by 4.48% (95% CI 2.47 to 6.48) with dietary advice and saturated fat intake fell by 2.39% (95% CI 1.4 to 3.37). \n\nTwo trials analysed incident cardiovascular disease (CVD) events. Follow‐up was 77% complete at 10 to 15 years after the end of the intervention period and estimates of event rates lacked precision but suggested that sodium restriction advice probably led to a reduction in cardiovascular events (combined fatal plus non‐fatal events) plus revascularisation (study 1 hazard ratio (HR) 0.59, 95% CI 0.33 to 1.08; study 2 HR 0.81, 95% CI 0.59 to 1.12). \n","Dietary advice appears to be effective in bringing about modest beneficial changes in diet and cardiovascular risk factors over approximately 12 months, but longer‐term effects are not known"]
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[null,"Ebrahim  S et al. Multiple risk factor interventions for primary prevention of coronary heart disease. Cochrane Database of Systematic Reviews 2011, Issue 1. Art. No.: CD001561. DOI: 10.1002/14651858.CD001561.pub3\nAvailable here.","Adult populations with a mean age of 35 or above. General populations could include workforce populations and high risk groups, as well as subjects who did not have a high risk of developing CHD.","This Cochrane review aimed to assess the effects of multiple risk factor interventions for reducing total mortality, fatal and non-fatal events from CHD and cardiovascular risk factors among adults assumed to be without prior clinical evidence of CHD. Types of interventions included health promotion activities to achieve behaviour change. More specifically counselling or educational interventions, with or without pharmacological treatments, that aimed to alter more than one cardiovascular risk factor. \n\nOverall, 55 trials (n=163,471) were included in the review. Blood pressure change was a secondary outcome , the results are reported below:\n\nFor both systolic and DBP, 48 trials (53 arms) indicated a significant reduction favouring intervention. The weighted mean difference between intervention and control was ‐2.71 mm Hg (95% CI ‐3.49 to ‐1.93; n = 64,809) for SBP and ‐2.13 mm Hg (95% CI ‐2.67 to ‐1.58; n = 75,400) for DBP using random‐effects models. In total, 24 trials reported that patients were on medication for high blood pressure. When analysis of outcomes was confined to these trials, strong evidence of reductions in both systolic and diastolic remained. This was also seen when the analysis was confined to trials where no medication was prescribed.\n\nNot all trials reported, or were able to provide data on, blood pressure at follow up. Overall, changes in blood pressure were small. For both outcomes there was no evidence of small study bias in the trials as shown by the funnel plots.\n\n\n","Interventions using counselling and education aimed at behaviour change do not reduce total or CHD mortality or clinical events in general populations but may be effective in reducing mortality in high‐risk hypertensive and diabetic populations. Risk factor declines were modest but owing to marked unexplained heterogeneity between trials, the pooled estimates are of dubious validity. Evidence suggests that health promotion interventions have limited use in general populations. "]
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[null,"Adolygiadau systemataidd eraill heb ffocws sylfaenol ar atal pwysedd gwaed uchel, ond sy’n cynnwys canlyniadau pwysedd gwaed ac sy’n cynnwys o leiaf rhai astudiaethau o boblogaethau heb bwysedd gwaed uchel"]
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[null,"Adolygiadau systemataidd"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Freak-Poli  RLA, et al. Workplace pedometer interventions for increasing physical activity. Cochrane Database of Systematic Reviews 2020, Issue 7. Art. No.: CD009209. DOI: 10.1002/14651858.CD009209.pub3. \nAvailable here.","Employed adults. Participants included both healthy populations and those at risk of chronic disease (e.g. through inactivity or overweight), with a mean age of 41 years.","The authors sought to assess the effectiveness of pedometer interventions in the workplace for increasing physical activity and improving long-term health outcomes. They included 14 studies, recruiting a total of 4762 participants. These studies were conducted in various high-income countries and in diverse workplaces (from offices to physical workplaces). \n\nWhen pedometer interventions are compared to minimal interventions at follow-up points at least one month after completion of the intervention, pedometers may have no effect on physical activity (6 studies; very low-certainty evidence; no meta-analysis due to very high heterogeneity), but the effect is very uncertain. Pedometers may have effects on sedentary behaviour but these effects were very uncertain (1 study; very low-certainty evidence). Pedometer interventions probably had little to no effect on blood pressure (systolic: -0.08 mmHg, 95%CI -3.26 to 3.11; 2 studies; moderate-certainty evidence). \n\nComparison of pedometer interventions to alternative physical activity interventions at follow-up points at least one month after completion of the intervention revealed that pedometers may have an effect on physical activity, but the effect is very uncertain (1 study; very low-certainty evidence). Sedentary behaviour and blood pressure (systolic or diastolic were not compared to an alternative physical activity intervention.\n","Exercise interventions can have positive effects on employee physical activity and health, although current evidence is insufficient to suggest that a pedometer-based intervention would be more effective than other options. It is important to note that over the past decade, technological advancement in accelerometers as commercial products, often freely available in Smartphones, has in many ways rendered the use of pedometers outdated. Future studies aiming to test the impact of either pedometers or accelerometers would likely find any control arm highly contaminated.\nDecision-makers considering allocating resources to large-scale programmes of this kind should be cautious about the expected benefits of incorporating a pedometer and should note that these effects may not be sustained over the longer term. \nFuture studies should be designed to identify the effective components of multi-component interventions, although pedometers may not be given the highest priority (especially considering the increased availability of accelerometers). Approaches to increase the sustainability of intervention effects and behaviours over a longer term should be considered, as should more consistent measures of physical activity and health outcomes.\nPedometers are now being largely replaced by more sophisticated devices such as accelerometers and Smartphone apps. For this reason, this is the final update of this review.\n"]
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[null,"Steed  L et al. Community pharmacy interventions for health promotion: effects on professional practice and health outcomes. Cochrane Database of Systematic Reviews 2019, Issue 12. Art. No.: CD011207.\nAvailable here.","Pharmacy workers, including pharmacists and counter assistants; adult pharmacy users with varying health conditions including: hypertension, diabetes, cardiovascular disease and dyslipidemia. ","The aim of this Cochrane review was to assess the effectiveness and safety of health‐promotion interventions to change community pharmacy workers' professional practice and improve outcomes for users of community pharmacies.\n\nThe authors included 57 randomised trials with 16,220 participants, described in 83 reports. Most interventions were educational, or incorporated skills training. Interventions were directed at pharmacy workers (n = 8), pharmacy users (n = 13), or both (n = 36). The clinical areas most frequently studied were diabetes, hypertension, asthma, and modification of cardiovascular risk. \n\nMost studies (47 of 57) were directed towards secondary prevention of conditions, including cardiovascular disease (1 study), type 2 diabetes (10 studies), dyslipidaemia (4 studies), and hypertension (4 studies). In approximately half of these conditions the intervention was described as being focused on the pharmacy user, whilst the other half mentioned some degree of training for the community pharmacy workers. \n\nThe authors conducted subgroup analyses for different patient behaviours, clinical conditions, and generic versus specific quality of life measures. When analysing the data across studies, when there were related outcomes from the same study, the authors used the most clinically rigorous measure. For hypertension this was: systolic blood pressure followed by diastolic blood pressure. Sub‐group analyses separated by condition suggested that interventions probably improve blood pressure in hypertension (SMD ‐0.34, 95% CI ‐0.49 to ‐0.18; I2 = 18%; 4 trials; 1050 participants; moderate‐certainty evidence; Analysis 1.2). Interventions probably improve blood glucose levels in diabetes (SMD ‐0.81, 95% CI ‐1.60 to ‐0.02; I2 = 96%; 6 trials; 651 participants; moderate‐certainty evidence; Analysis 1.2), though the high level of heterogeneity is important here. Interventions probably made little or no difference for cardiovascular risk (SMD ‐0.08, 95% CI ‐0.40 to 0.24; I2 = 0%; 2 trials, 150 participants; moderate‐certainty evidence; Analysis 1.2). \n\nMost studies (35 of 57) included some level of intermediate clinical outcome. The ones measured most consistently were in asthma (9 studies), diabetes (10 studies) and cardiovascular risk (hypertension (8 studies) and dyslipidaemia (4 studies)). Health‐promotion interventions probably improve intermediate clinical outcomes slightly in pharmacy users (SMD ‐0.43, 95% CI ‐0.65 to ‐0.21; I2 = 90%; 20 trials, 3971 participants; moderate‐certainty evidence).","The findings of this review suggest that the community pharmacy is potentially a helpful setting in which to offer behavioural and health‐promotion interventions. There is evidence to suggest that such interventions probably slightly improve pharmacy user health‐related behaviour, intermediate clinical outcomes ‐ particularly for diabetes and hypertension ‐ and quality of life.\n\nSuch interventions are likely to be cost‐effective and the effects are seen across a range of clinical conditions and health‐related behaviours. Nevertheless the magnitude of the effects varies between conditions, and more effective interventions might be developed if greater consideration were given to the theoretical basis of the intervention and mechanisms for effecting behaviour change. \n\nIn summary, health‐promotion interventions in the community pharmacy context probably improve pharmacy workers' behaviour and probably have a slight beneficial effect on health‐related behaviour, intermediate clinical outcomes, and quality of life for pharmacy users. "]
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[null,"Brown TJ, Todd A, O'Malley CL, Moore HJ, Husband AK, Bambra C, et al. Community pharmacy interventions for public health priorities: a systematic review of community pharmacy-delivered smoking, alcohol and weight management interventions. Public Health Research 2016;4(2)\nAvailable here","Adults including some studies focused on adults with the comorbidity of high blood pressure.","The review included five weight loss and five multicomponent interventions that included pharmacotherapy and lifestyle changes in participants with diabetes mellitus, dyslipidaemia or hypertension.\nNine of the studies were UK based; seven of the studies were rated ‘strong’ for quality. All studies were of adults.\nEvidence suggests that pharmacy-based weight-loss interventions are as effective as similar interventions in other primary care settings, but not as effective or cost-effective as commercially provided weight management services based in community settings. \nNone of the five multicomponent studies demonstrated an improvement compared with control for anthropometric outcomes in participants with comorbidities, but they did show improvement in measures associated with the comorbidities. The evidence suggests that a distinct group of people might access pharmacies compared with other settings for weight loss. \nThere is insufficient evidence to examine the relationship between behaviour change strategies and effectiveness; or evidence of consistent implementation factors or training components that underpin effective interventions.","Pharmacy-based weight loss interventions appear to be\nas effective as similar interventions in other primary care settings, but not as effective or cost-effective as\ncommercially provided weight management services in community settings. No study assessed the\ndifferential effects of any measure of SES; therefore, the impact of any of the interventions on health\ninequalities is unknown.\nEvaluations of interventions to manage alcohol misuse and obesity, set within the community pharmacy, are needed. The effect of community pharmacy interventions on health inequalities is unclear. Future research in this area is warranted, and trials should include the assessment of age, sex, ethnicity, socioeconomic status and contextual factors, and present analysis of how these factors moderate effectiveness. "]
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[null,"Campbell F, Holmes M, Everson-Hock E, Davis S, Buckley Woods H, Anokye N, et al. A systematic review and economic evaluation of exercise referral schemes in primary care: A short report. Health Technology Assessment 2015;19(60)\nAvailable here\n\nReport based on:\nPavey T, Anokye N, Taylor A, Trueman P, Moxham T. The clinical effectiveness and cost-effectiveness of exercise referral schemes: a systematic review and economic evaluation. Health Technology Assessment 2011;15(44)\nAvailable here","Adults ","This report is based on the 2011 systematic review by Pavey et al.\n\nThe proportion of individuals achieving 90–150 minutes of at least moderate-intensity activity per week at 6–12 months’ follow-up was greater for ERSs than usual care (relative risk 1.12; 95% confidence interval 1.04 to 1.20). \nOlder patients and those referred for CHD risk factors appeared to be more likely than others to increase their levels of physical activity. Qualitative evidence suggests that interventions enabling the development of social support networks are beneficial in promoting uptake and adherence. \nReferral to an ERS did not lead to changes in objective measures of health such as weight or blood pressure.","Exercise referral schemes result in a small improvement in the number of people who increase their levels of physical activity. \nThe cost-effectiveness analysis indicates that the ICER for ERSs compared with usual care is around £76,000 per QALY, although the cost-effectiveness of ERSs is subject to considerable uncertainty.\nThere was no evidence that\nthe interventions lead to positive changes in body fat, BMI or blood pressure."]
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[null,"Harris J, Felix L, Miner A, Murray E, Michie S. Adaptive e-learning to improve dietary behaviour: a systematic review and cost-effectiveness analysis. Health Technology Assessment 2011;15(37)\nAvailable here\n","Participants aged greater than 13 years. Most studies involved adults aged 40-49 years.","The most commonly used behavioural change techniques reported to have been used were: goal setting; feedback on performance; information on consequences of behaviour in general; barrier identification/problem solving; prompting self-monitoring of behaviour; and instruction on how to perform the behaviour.\n\nThere was substantial heterogeneity in the estimates of effect. E-learning interventions were associated with a WMD of +0.24 (95% CI 0.04 to 0.44) servings of fruit and vegetables per day; -0.78 g (95% CI -2.5 g to 0.95 g) total fat consumed per day; -0.24 g (95% CI -1.44 g to 0.96 g) saturated fat intake per day; -1.4% (95% CI -2.5% to -0.3%) of total energy consumed from fat per day; +1.45 g (95% CI -0.02 g to 2.92 g) dietary fibre per day; +4 kcal (95% CI -85 kcal to 93 kcal) daily energy intake; -0.1 kg/m2 (95% CI -0.7 kg/m2 to 0.4 kg/m2) change in body mass index. \n\nFor blood pressure change as an outcome, the combined summarised result for the two studies focussed on systolic blood pressure was WMD 0.39 (mmHg) ranging between (−3.23 to 4.01) when using 95% CI. For diastolic blood pressure the summarised WMD was -0.30 (mmHg) ranging between (-0.49 to -0.11) when using 95% CI. ","There are many factors affecting what foods people eat and why, and an intervention targeted\nat individual behaviour change can address only a selection of these. E-learning has not yet\nproved itself to be more effective or cost-effective than other behaviour change approaches at an\nindividual level for improving diet, or for preventing or reducing overweight or obesity. Nor is\nthere any research comparing e-learning approaches with population-level approaches to tackling\ndietary change or reducing obesity."]
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[null,"Peirson L et al. Prevention of overweight/obesity in adult populations: a systematic review with meta-analyses. Ottawa, Ontario: Canadian Task Force on Preventive Health Care; 2014.\nAvailable here. ","Adults of normal weight (BMI >18 and <25) In the absence of this statement the authors accepted studies when the baseline mean BMI minus one standard deviation (SD) fell below 25 kg/m2; they assumed that this result meant there were some normal weight people in the sample.","The review aimed to synthesise evidence on behavioural interventions for preventing weight gain in normal weight adults. Blood pressure change was a secondary outcome of the review and the results are reported below: \n\nSeventeen RCTs (n=48,493) of very low GRADE quality (downgraded for risk of bias, inconsistency, indirectness and imprecision) were included in the meta-analysis assessing change in SBP. Across these studies, baseline BMI ranged from 22.4 to 31.1; in four of the studies the baseline mean BMI of at least one study arm was <25; in 13 studies the baseline means were in the range for overweight/obese. In terms of type of intervention three were diet, three were exercise, three were diet plus exercise, and eight were lifestyle. Control participants received usual care from their physicians or no intervention; in five of these studies control participants received a minimal component (e.g. printed materials on healthy lifestyles). Intervention duration was 12 months or less in 12 studies and more than 12 months in five studies. There was no difference between intervention and control group participants in terms of change in SBP [MD (95% CI) -0.31 mm Hg (-0.84, 0.22); I2=77%]. \n\nFifteen RCTs (n=47,945) of very low GRADE quality (downgraded for risk of bias, inconsistency, indirectness and imprecision) were included in the meta-analysis assessing change in DBP. Across these studies, baseline BMI ranged from 22.4 to 31.1; in four of the studies the baseline mean BMI of at least one study arm was <25; in 11 studies the baseline means were in the range for overweight/obese. In terms of type of intervention three were diet, two were exercise, three were diet plus exercise and seven were lifestyle. Control participants received usual care from their physicians or no intervention; in five of these studies control participants received a minimal component (e.g. printed materials on healthy lifestyles). Intervention duration was 12 months or less in 10 studies and more than 12 months in five studies. There was no difference between intervention and control group participants in terms of change in DBP [MD (95% CI) -0.18 mm Hg (-0.44, 0.07); I2=66%]. \n\n","There is low quality evidence that behavioural interventions are associated with reductions in weight and improvements in other health outcomes in mixed weight adult populations, but it is uncertain whether the benefits are clinically meaningful and can be maintained over time. In the short term, strategies aimed at weight maintenance appear to have some benefit; if maintained, these could be clinically significant benefits.\n\nThe review authors state that results presented for secondary health outcomes (including blood pressure) should be interpreted with caution as they only included interventions that had a focus on weight gain prevention. "]
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[null,"Carr S et al.  An evidence synthesis of qualitative and quantitative research on component intervention techniques, effectiveness, cost-effectiveness, equity and acceptability of different versions of health-related lifestyle advisor role in improving health. Health Technology Assessment 2011; 15(9).\nAvailable here.","General adult population","This review aimed to identify and analyse the range of models developed to date for delivering health-related lifestyle advice (HRLA), or training, for effectiveness and cost-effectiveness in improving the health and well-being of individuals and communities in the UK.\n\nOverall, there was insufficient evidence to either support or refute the use of LAs to promote health and improve quality of life. The economic analysis showed that LA interventions were not cost-effective for diet/physical activity.\n\nFive studies were identified in relation to diet and exercise. Two examined healthy diet promotion alone and three examined the promotion of healthy diet and greater levels of physical activity. Three of the studies assessed a variety of physiological measures, the majority of which did not differ significantly between the groups. However, (Staten 2004) found small but statistically significant reductions in systolic blood pressure. The study (Staten 2004) reported on change in systolic blood pressure in an intervention group with a Community Health Worker versus two other groups that had provider counselling and health education. There were significant reductions in systolic blood pressure in the CHW group (approximately 5.4 mmHg – insufficient information to calculate effect size) versus both other groups (linear regression unadjusted).","Evidence was variable, giving only limited support to LAs having a positive impact on health knowledge, behaviours and outcomes. Levels of acceptability appeared to be high. LAs acted as translational agents, sometimes removing barriers to prescribed behaviour or helping to create facilitative social environments. \n\nReporting of processes of accessing or capitalising on indigenous knowledge was limited. Ambiguity was apparent with respect to the role and impact of lay and peer characteristics of the interventions. \n\nA future programme of research on HRLA could benefit from further emphasis on identification of needs, the broadening of population focus and intervention aims, the measurement of outcomes and the reviewing of evidence."]

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[null,null,null,"Include"]
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[null,"Canllawiau ar adnabod / monitro"]
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[null,"Canllaw penodol ar bwysedd gwaed uchel"]
[null,"Ffynhonnell:","Cynulleidfa:","Argymhellion:"]
[null,"BMJ Best Practice. (2019). Essential Hypertension. London: BMJ Publishing Group Ltd. \nAvailable here.\n\nLast updated March 2019.","Medical professionals situated outside of the United States and Canada. ","The BMJ Best Practice summary on essential hypertension includes information on the definition, epidemiology, aetiology and pathophysiology of hypertension, along with information on prevention, diagnosis, treatment and follow-up and details of current diagnostic and treatment guidelines.\n\nIt states that hypertension is typically diagnosed by screening of an asymptomatic individual. Treatment of uncontrolled hypertension reduces the risks of mortality and of cardiac, vascular, renal and cerebrovascular complications. Lifestyle changes are recommended for all patients: weight loss, exercise, decreased sodium intake, dietary approaches to stop hypertension (DASH) and moderation of alcohol consumption. Choice of drug therapy is often driven by considerations related to comorbid disease, but achievement of blood pressure goal may be accomplished with a variety of therapeutic agents. "]
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[null,"BMJ Best Practice. (2019). Assessment of Hypertension. London: BMJ Publishing Group Ltd. \nAvailable here.\n\nLast updated Feb 2019.","Medical professionals situated outside of the United States and Canada. ","This BMJ Best Practice summary on assessment of hypertension includes information on the aetiology of hypertension, urgent considerations in emergencies and diagnosis. \n\nIt states that the 2017 American Collge of Cardiology (ACC)/ American Heart Association (AHA) guidelines for the prevention, detection, evaluation, and management of high blood pressure in adults defines hypertension as any systolic blood pressure (SBP) measurement of ≥130 mm Hg or any diastolic blood pressure (DBP) measurement of ≥80 mm Hg. ACC/AHA blood pressure categories are defined as follows:\n\n - Elevated blood pressure: SBP of 120-129 mm Hg and DBP of <80 mm Hg. \n - Stage 1 hypertension: SBP of 130-139 mm Hg and/or DBP of 80-89 mm Hg.\n - Stage 2 hypertension: SBP of ≥140 mm Hg and/or DBP of ≥90 mm Hg.\n\nEuropean guidelines categorise hypertension as follows:\n - High-normal: systolic 130-139 mm Hg and/or diastolic 85-89 mm Hg\n - Grade 1: systolic 140-159 mm Hg and/or diastolic 90-99 mm Hg\n - Grade 2: systolic 160-179 mm Hg and/or diastolic 100-109 mm Hg\n - Grade 3: systolic ≥180 mm Hg and/or diastolic ≥110 mm Hg. \n\nGuidelines on the management of hypertension emphasise the importance of calculating and managing the overall cardiovascular risk of a patient, rather than focusing only on blood pressure readings. "]
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[null,"National Institute for Health and Care Excellence. Hypertension in adults. QS28. London: NICE, 2013. \nAvailable here.\n\nLast updated September 2015. ","This quality standard should be used by commissioners and providers of health and social care when designing high-quality services and could also be used by patients, service users and carers to find out about the quality of care they should expect to receive; support asking questions about the care they receive; and to make a choice between providers of social care services. ","This quality standard covers managing hypertension in adults. It includes diagnosis and investigations, treatment and specialist referral. It describes high-quality care in priority areas for improvement.\n\nThe quality standard for hypertension states that services should be commissioned from and coordinated across all relevant agencies encompassing the hypertension care pathway. A person-centred approach to provision of services is fundamental in delivering high-quality care to adults with hypertension.\n\nThe quality statements are as follows:\n\n -  Statement 1: People with suspected hypertension are offered ambulatory blood pressure monitoring (ABPM) to confirm a\n     diagnosis of hypertension.\n\n -  Statement 2: People with newly diagnosed hypertension receive investigations for target organ damage within 1 month\n     of diagnosis. \n\n -  Statement 3: This statement has been replaced by quality statements on primary and secondary prevention of\n     cardiovascular disease in cardiovascular disease risk assessment and lipid modification (NICE quality standard 100).\n\n -  Statement 4: People with treated hypertension have a clinic blood pressure target set to below 140/90 mm Hg if aged\n     under 80 years, or below 150/90 mm Hg if aged 80 years and over.  \n\n -  Statement 5: People with hypertension are offered a review of risk factors for cardiovascular disease annually.\n\n -  Statement 6: People with resistant hypertension who are receiving four antihypertensive drugs and whose blood\n     pressure remains uncontrolled are referred for specialist assessment. \n\nOther quality standards that should also be considered when choosing, commissioning or providing a high-quality hypertension service are listed in related NICE quality standards.\n\n"]
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[null,"National Institute for Heath and Care Excellence. Hypertension in adults: diagnosis and management. NG136. London: NICE, 2019\nAvailable here.\n\n\n\nUnderpining evidence available here.\n\n\n\n\n","This guideline is for:\nHealthcare professionals;\nCommissioners, and providers;\nPeople who have or may have high blood pressure, their families and carers.","This guideline covers identifying and treating primary hypertension (high blood pressure) in people aged 18 and over, including people with type 2 diabetes. It aims to reduce the risk of cardiovascular problems such as heart attacks and strokes by helping healthcare professionals to diagnose hypertension accurately and treat it effectively.\n\nThis guideline includes new and updated recommendations on:\n-diagnosing hypertension\n-starting antihypertensive drug treatment\n-monitoring treatment and blood pressure targets\n-choosing antihypertensive drug treatment (treatment steps 1 to 4)\n-who to refer for same-day specialist review\n\nIt also includes unchanged recommendations on:\n-measuring blood pressure\n-assessing cardiovascular risk and target organ damage\n-lifestyle interventions\n\n"]
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[null,"Adnabod: sgrinio"]
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[null,"Adolygiadau systemataidd"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Schmidt  B-M, et al. Screening strategies for hypertension. Cochrane Database of Systematic Reviews 2020, Issue 5. Art. No.: CD013212. DOI: 10.1002/14651858.CD013212.pub2.\nAvailable here.","Healthy adolescents, adults, and elderly people participating in mass, targeted, or opportunistic screening of hypertension.","The authors screened 9335 titles and abstracts. They identified 54 potentially eligible studies for full‐text screening. However, no studies met the eligibility criteria.\n\nDue to identified gaps in the current evidence base, the authors are unable to highlight clear implications for Hypertension screening policy.","There is an implicit assumption that early detection of hypertension through screening can reduce the burden of morbidity and mortality, but this assumption has not been tested in rigorous research studies.\n \nHigh‐quality evidence from RCTs or programmatic evidence from NRCTs on the effectiveness and costs or harms of different screening strategies for hypertension (mass, targeted, or opportunistic) to reduce hypertension‐related morbidity and mortality is lacking."]
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[null,"Neary M et al. Screening for hypertension. Ottawa, Ontario: Canadian Task Force on Preventive Health Care; 2014. \nAvailable here. ","Adults aged 18+ from the general population including subsets with higher than average risk of hypertension, vascular risk and average baseline blood pressure. ","This review aimed to summarise the evidence on screening for hypertension (detecting undiagnosed hypertension) in primary care. The review aims to determine the effectiveness of hypertension screening in primary care in reducing the risk of cardiovascular events and all-cause mortality. Determining the effectiveness of screening in reducing blood pressure (BP) is a subsidiary aim. The harms of hypertension screening – excluding harms caused by treatment – were also  reviewed.\n\nThis review found no controlled studies of the effectiveness of screening for\nhypertension in primary care. It did find one cluster randomised trial assessing whether a community-based cardiovascular screening program that included hypertension screening is superior to usual screening practice and one modelling study that met inclusion criteria for studies on the benefits of hypertension screening. There were no studies that met the inclusion criteria for identifying the optimal frequency and/or timing of screening for identifying patients who might benefit from treatment, nor for identifying specific criteria that should trigger an increase\nin the frequency of screening. No studies that met the inclusion criteria were found to address the harms ranked ‘critical’ by the Hypertension Working Group. However, two papers (and one companion paper) of interest were identified regarding the consequences of informing patients of a new diagnosis of hypertension.\n\n","In this review, there were no studies identified that specifically and directly assessed whether screening for hypertension in primary care practice reduces the risk of\ncardiovascular morbidity, cardiovascular mortality, and all-cause mortality and/or whether it\nleads to sustained reductions in blood pressure. There were no studies identified that assessed whether measuring blood pressure at most clinical encounters in primary care achieved the desired cardiovascular morbidity or mortality outcomes or sustained reductions in blood pressure. However, in light of some evidence for benefit from a more intense (cardiovascular) screening program that included hypertension screening and the overwhelming evidence that treating patients diagnosed with hypertension improves patient outcomes, there is indirect evidence to support screening for hypertension by measuring blood pressure in most primary care encounters rather than screening less frequently. "]
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[null,"Brunton G et al. Developing evidence-informed, employer-led workplace health. London: EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London; 2016. Available here.","Male NHS employees","One included study (Lomas and McCluskey, 2005) aimed to evaluate the effectiveness of a workplace health promotion initiative. Blood screening was taken into the workplace setting for all staff members who wished to take part.\n\nThis study examined the perceptions of male NHS workers across a range of worksites who took part in a blood pressure screening intervention. The authors were interested in men’s perceptions of the experience and the impact of screening on men’s health decision-making processes, and they aimed to identify ways to improve the intervention. Semi-structured interviews were conducted with workers and managers, and thematic analysis undertaken. The overall\nusefulness rating for this study was high. The sample covered a broad range of work roles in the NHS, and the intervention, which was specifically targeted towards men, resulted in a successful outcome. By offering blood pressure screening on site, the male participants were more likely to take an interest in their own health. Other factors which encouraged participation were the professionalism of the deliverer, the effort made with regard to the welfare of the recruits, and external and internal support.","The overall review (synthesis of views studies (n=10) and policy report (n=14) suggests that 'managerial support’ is a key mechanism for the successful implementation of workplace health. Characteristics relate to all levels of managerial roles/responsibilities and are applicable to companies of different sizes and scales. Key points have been highlighted:\n- Managers could encourage staff to participate in workplace health, e.g. web-based health programmes, blood pressure screenings, weight management or mental health\ninitiatives, or could support employees’ career progression.\n- Managers could provide ongoing support and ‘follow up’: follow up, such as reminders and communication about workplace health, is perceived as leading to ongoing commitment from staff."]
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[null,"Adnabod: asesu risg"]
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[null,"Adolygiadau systemataidd"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Dyakova  M et al.  Systematic versus opportunistic risk assessment for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2016, Issue 1. Art. No.: CD010411. DOI: 10.1002/14651858.CD010411.pub2.\nAvailable here. ","Healthy adults from the general population including those who are at risk of CVD.","This Cochrane review aimed to assess the effectiveness, costs and adverse effects of systematic risk assessment compared to opportunistic risk assessment for the primary prevention of CVD. \n\nNine completed RCTs met the inclusion criteria for the review, of which four were cluster‐randomised. The authors also identified five ongoing trials. The included studies had a high or unclear risk of bias, and the GRADE ratings of overall quality were low or very low. Blood pressure change was a secondary outcome for the review, the results are reported below: \n\nSix studies reported SBP at follow‐up and were combined in a meta‐analysis. Mean SBP was lower in the intervention group compared with the control group (MD ‐3.05 mm Hg, 95% CI ‐4.84 to ‐1.25; participants = 12,591; studies = 6; I² = 82%; very low‐quality evidence). There was considerable statistical heterogeneity, so review auhtors combined the data with a random‐effects model. Sensitivity analysis suggested that BFHS 1994 had a considerable impact on the results. Removing this study from the analysis reduced statistical heterogeneity to 0% and reduced uncertainty, as demonstrated by a narrower confidence interval. The mean difference, although slightly less, remained statistically significant (MD ‐1.91 mm Hg, 95% CI ‐2.67 to ‐1.16; participants = 10,584; studies = 5; I² = 0%). \n\nSix studies reported DBP at follow‐up and were combined in a meta‐analysis. Mean DBP was lower in the intervention group compared with the control group (MD ‐1.34 mm Hg, 95% CI ‐1.76 to ‐0.93; participants = 12,591; studies = 6; I² = 0%; low‐quality evidence). ","The results are limited by the heterogeneity between trials in terms of participants recruited, interventions and duration of follow‐up. Limited data suggest that systematic risk assessment for CVD has no statistically significant effects on clinical endpoints. There is limited evidence to suggest that CVD systematic risk assessment may have some favourable effects on cardiovascular risk factors. The completion of the five ongoing trials will add to the evidence base. "]
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[null,"Monitro"]
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[null,"Adolygiadau systemataidd"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Cardiovascular disease prevention: Interactive digital interventions for blood pressure self-management. The Community Guide; 2017.\nAvailable here. ","Participants with high blood pressure. ","This report examines interactive digital interventions for blood pressure self-management, leading to a Community Preventative Task Force (CPSTF) recommendation on the subject. The CPSTF finding is based on the results of a published systematic review (McLean G, Band R, Saunderson K, Hanlon P, Murray E, et al. Digital interventions to promote self-management in adults with hypertension: systematic review and meta-analysis. Journal of Hypertension 2016;34(4):600-12) which included seven RCTs of trials examining the impact of digital interventions on systolic and DBP among recruited participants with high blood pressure. The CPSTFs conclusion of sufficient evidence was based on the magnitude of effect estimates, number of studies, and consistency of effects. \n \nA statistically significant effect for digital interventions was found when pooling results for both SBP (MD -3.7 mm Hg [95% CI -5.3 to -2.2]; six studies) and DBP (MD -2.4 mm Hg [95% CI -4.4 to -0.04]; five studies. One included study also examined the proportion of patients achieving or maintaining blood pressure control. At 24 month follow-up, intervention group participants were significantly more likely to have their blood pressure under control (odds ratio 1.52; [95% CI 1.01 to 2.30]).\n","The Community Preventive Services Task Force (CPSTF) recommends interactive digital interventions for patients who have high blood pressure based on sufficient evidence of effectiveness in reducing blood pressure. Evidence was considered sufficient based on studies that demonstrated improvements in patients’ blood pressure measurements over intervention periods of six weeks to 24 months (median six months)."]
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[null,"Canadian Agency for Drugs and Technologies in Health. Telehealth for patients with Hypertension, Coronary Artery Disease or Implantable Cardiac Devices: A Review of the Clinical Effectiveness, Cost-effectiveness and Guidelines. Rapid response report: summary with critical appraisal. CADTH; 2016. \nAvailable here. ","Patients with hypertension, CAD and implantable cardiac devices requiring cardiac care. ","This rapid response report aims to review the clinical- and cost-effectiveness of telehealth for patients with hypertension, coronary artery disease (CAD) or conditions requiring implantable cardiac devices.\n\nA total of twelve studies on telehealth for hypertension (four studies), CAD (two studies) and implantable cardiac devices (six studies) were included in the review. Five studies were systematic reviews on clinical effectiveness of telemonitoring, six were cost-effectiveness studies and one was a guideline. \n\nClinical evidence of telehealth for patients with hypertension: \n\nOne systematic review which evaluated the clinical effectiveness of home blood pressure telemonitoring (HBPT) was identified. The systematic review/meta-analysis included 23 RCTs that evaluated the clinical effectiveness of home blood pressure telemonitoring (HBPT), compared to usual care, in adult patients with hypertension, with mean SBP of 144.9 ± 11.4 (SD), and mean DBP of 84.5 ± 5.7 (SD). HBPT was found to improve SBP and DBP, with a difference of 4.71 mm Hg and 2.45 mm Hg, respectively, compared to usual care. The differences were statistically significant. HBPT also increased the chances for patients to achieve office BP normalisation in both diabetic and non-diabetic populations by 16% (relative risk [RR] 1.16; p < 0.001). HBPT helped improve the physical component of quality of life (SF-12 or SF-36 questionnaire: weighted mean difference [WMD] +2.78; 95% confidence interval [CI] +1.15 to +4.41; p < 0.001). There was no statistically significant difference in both intervention and usual care groups in terms of therapeutic adherence, rate of office consultations, and risk of adverse events.\n\n\n","Telemonitoring of blood pressure costs more than usual care, but it may represent a useful tool for hypertension control by improving blood pressure and increasing the chances for patients to achieve blood pressure normalisation. There was no evidence available on the cost-effectiveness of telemonitoring in patients with CAD requiring cardiac rehabilitation, but telehealth interventions do not have inferior outcomes compared to centre-based supervised programs, and telephone support may reduce hospitalisations and reduce risk factors for heart disease. For patients with heart diseases requiring implantable cardiac devices, the costs of telemonitoring were lower than conventional hospital monitoring. Pacemaker telemonitoring led to earlier cardiovascular event detection, with a reduction in hospital visits and hospitalisations. Telemonitoring of implantable cardioverter-defibrillators had similar outcomes compared to in-office follow-up."]
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[null,"Community Preventive Services Task Force. Cardiovascular Disease Prevention and Control: Self-Measured Blood Pressure Monitoring Interventions for Improved Blood Pressure Control. Task Force Findings and Rationale Statement; 2015.\nAvailable here.\n\nLast updated June 2016. ","Unspecified.","This Community Preventive Service Task Force finding is based on evidence from a systematic review published in 2013 which evaluated the effectiveness of self-measured blood pressure monitoring interventions when used alone or when combined with additional support to manage high blood pressure. For studies evaluating self-measured blood pressure monitoring alone, a meta-analysis was conducted and reported relative risks and weighted net differences across multiple time points. Because of clinical heterogeneity, however, only narrative results were reported for self-measured blood pressure monitoring combined with additional support. To better inform Task Force conclusions on health impact estimates were transformed into absolute percentage point changes and net differences using the latest time point available.\n\nThe finding of sufficient evidence of effectiveness for self-measured blood pressure monitoring interventions when implemented alone is based on evidence from 26 studies with 28 study arms. Patients in these studies received blood pressure monitoring devices, were trained to use them and shared blood pressure readings with their healthcare providers. Results demonstrated consistent and meaningful improvements in blood pressure when the intervention was compared with usual care. Results were statistically significant at the six month time point and continued to be favourable at 12 months, although smaller in magnitude.\n\nThe finding of strong evidence of effectiveness for self-measured blood pressure monitoring interventions when combined with additional support is based on evidence from 25 studies with 29 study arms. Additional support varied between studies and was categorized into three main groups: one-on-one patient counselling or telecounseling (11 studies), access to electronic or web-based tools (seven studies), and education on high blood pressure and blood pressure self-management (five studies). Half of these studies were conducted using a team-based care arrangement where health care providers worked alongside other professionals, such as nurses and pharmacists, to improve coordination of care and support for patients (14 studies with 17 study arms). Results demonstrated consistent and meaningful improvements in blood pressure that were sustained at 12 months when the intervention was compared with usual care.\n\n","The Community Preventive Services Task Force recommends self-measured blood pressure monitoring interventions to improve blood pressure outcomes in patients with high blood pressure. There is sufficient evidence of effectiveness for self-measured blood pressure monitoring interventions when used alone (i.e. patients receive self-measured blood pressure tools, training, and monitoring). There is strong evidence of effectiveness for these interventions when combined with additional support (i.e. patient counselling, education, or web-based support). The economic evidence indicates that self-measured blood pressure monitoring interventions are cost-effective when they are used with additional support or within team-based care."]
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[null,"Flodgren  G et al. Interactive telemedicine: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD002098. DOI: 10.1002/14651858.CD002098.pub2.\nAvailable here. ","Participants with any chronic condition (including those with hypertension).","This Cochrane review aimed to assess the effectiveness, acceptability and costs of interactive telemedicine as an alternative, or in addition to, usual care (i.e. face-to-face care or telephone consultation). \n\nNinety-three trials were included in the review (n=22,047 participants) which evaluated the effectiveness of interactive telemedicine delivered in addition to (32% of studies), as an alternative to (57% of studies), or partly substituted for usual care (11%) as compared to usual care alone. Four studies were in participants with hypertension.\n\nIn the studies assessing telemedicine in patients with hypertension, blood pressure measurement varied among studies at follow‐up. One study (n = 387) reported a greater decrease in mean SBP in telemedicine delivered care in addition to usual care, as compared with usual care alone at 12 months; one study (n = 236) reported no differences in diastolic daytime and night time ambulatory blood pressure (ABPM) between groups at six months but did report that a greater proportion of intervention patients achieved a target BP at six months. One study (n = 121) reported a greater decrease in 24‐hour systolic and diastolic ABPM and a greater change in mean BP in the telemedicine group at eight weeks, as compared with control. In one monitoring study with automated review of data with alerts (n = 329), the authors reported a greater proportion of telemedicine participants achieving daytime normalisation of arterial BP as compared with control.","The findings in our review indicate that the use of telemedicine in the management of heart failure appears to lead to similar health outcomes as face‐to‐face or telephone delivery of care; there is evidence that telemedicine can improve the control of blood glucose in those with diabetes. The cost to a health service and acceptability by patients and healthcare professionals, is not clear due to limited data reported for these outcomes. The effectiveness of telemedicine may depend on a number of different factors, including those related to the study population e.g. the severity of the condition and the disease trajectory of the participants, the function of the intervention e.g., if it is used for monitoring a chronic condition, or to provide access to diagnostic services, as well as the healthcare provider and healthcare system involved in delivering the intervention."]
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[null,"Canadian Agency for Drugs and Technologies in Health. Blood pressure monitoring chairs to identify hypertension: a review of the clinical effectiveness and guidelines. Ottawa: CADTH; 2011.\nAvailable here.  ","Unspecified.","This CADTH report aimed to review and critically appraise the quality of evidence-based guidelines, health technology assessments, systematic reviews, meta-analyses, and RCTs evaluating the clinical effectiveness of blood pressure monitoring (BPM) chairs, relative to auscultatory and automated methods.\n\nNo relevant health technology assessments, systematic reviews, meta-analyses or RCTs were identified in the literature search. One evidence-based North American guideline discussing a role for BPM chairs in the identification of hypertension was identified.\n\n","Insufficient research has been conducted to validate the clinical effectiveness of BPM chairs for reliably identifying hypertensive patients. Evidence-based clinical guidelines do not incorporate BPM chairs into algorithms for the diagnosis of hypertension, and acknowledge the lack of research towards their validation."]

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[]
[null,null,null,"Include"]
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[null,"Canllaw"]
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[null,"Canllaw penodol ar bwysedd gwaed uchel"]
[null,"Ffynhonnell:","Cynulleidfa:","Argymhellion:"]
[null,"BMJ Best Practice. Essential Hypertension. London: BMJ Publishing Group Ltd; 2019.\nAvailable here.\n\nLast updated March 2019.","Medical professionals situated outside of the United States and Canada. ","The BMJ Best Practice summary on essential hypertension includes information on the definition, epidemiology, aetiology and pathophysiology of hypertension, along with information on prevention, diagnosis, treatment and follow-up and details of current diagnostic and treatment guidelines.\n\nIt states that hypertension is typically diagnosed by screening of an asymptomatic individual. Treatment of uncontrolled hypertension reduces the risks of mortality and of cardiac, vascular, renal and cerebrovascular complications. Lifestyle changes are recommended for all patients: weight loss, exercise, decreased sodium intake, dietary approaches to stop hypertension (DASH) and moderation of alcohol consumption. Choice of drug therapy is often driven by considerations related to comorbid disease, but achievement of blood pressure goal may be accomplished with a variety of therapeutic agents. "]
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[null,"National Institute for Health and Care Excellence. Hypertension in adults. QS28. London: NICE, 2013. \nAvailable here.\n\nLast updated September 2015. ","This quality standard should be used by commissioners and providers of health and social care when designing high-quality services and could also be used by patients, service users and carers to find out about the quality of care they should expect to receive; support asking questions about the care they receive; and to make a choice between providers of social care services. ","This quality standard covers managing hypertension in adults. It includes diagnosis and investigations, treatment and specialist referral. It describes high-quality care in priority areas for improvement.\n\nThe quality standard for hypertension states that services should be commissioned from and coordinated across all relevant agencies encompassing the hypertension care pathway. A person-centred approach to provision of services is fundamental in delivering high-quality care to adults with hypertension.\n\nThe quality statements are as follows:\n\n -  Statement 1: People with suspected hypertension are offered ambulatory blood pressure monitoring (ABPM) to confirm a\n     diagnosis of hypertension.\n\n -  Statement 2: People with newly diagnosed hypertension receive investigations for target organ damage within 1 month\n     of diagnosis. \n\n -  Statement 3: This statement has been replaced by quality statements on primary and secondary prevention of\n     cardiovascular disease in cardiovascular disease risk assessment and lipid modification (NICE quality standard 100).\n\n -  Statement 4: People with treated hypertension have a clinic blood pressure target set to below 140/90 mm Hg if aged\n     under 80 years, or below 150/90 mm Hg if aged 80 years and over.  \n\n -  Statement 5: People with hypertension are offered a review of risk factors for cardiovascular disease annually.\n\n -  Statement 6: People with resistant hypertension who are receiving four antihypertensive drugs and whose blood\n     pressure remains uncontrolled are referred for specialist assessment. \n\nOther quality standards that should also be considered when choosing, commissioning or providing a high-quality hypertension service are listed in related NICE quality standards.\n\n"]
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[null,"National Institute for Heath and Care Excellence. Hypertension in adults: diagnosis and management. NG136. London: NICE, 2019\nAvailable here.\n\n\n\nUnderpinning evidence available here.\n\n\n\n\n","This guideline is for:\nHealthcare professionals;\nCommissioners, and providers;\nPeople who have or may have high blood pressure, their families and carers.","This guideline covers identifying and treating primary hypertension (high blood pressure) in people aged 18 and over, including people with type 2 diabetes. It aims to reduce the risk of cardiovascular problems such as heart attacks and strokes by helping healthcare professionals to diagnose hypertension accurately and treat it effectively.\n\nThis guideline includes new and updated recommendations on:\n-diagnosing hypertension\n-starting antihypertensive drug treatment\n-monitoring treatment and blood pressure targets\n-choosing antihypertensive drug treatment (treatment steps 1 to 4)\n-who to refer for same-day specialist review\n\nIt also includes unchanged recommendations on:\n-measuring blood pressure\n-assessing cardiovascular risk and target organ damage\n-lifestyle interventions\n\n"]
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["s","Canllaw ehangach ar atal ffactorau risg ar gyfer pwysedd gwaed uchel"]
[null,"Ffynhonnell:","Cynulleidfa:","Argymhellion:"]
[null,"National Institute for Health and Care Excellence. Community pharmacies: promoting health and wellbeing. NG102. London: NICE; 2018.\nAvailable here.  \n\nUnderpinning evidence reviews:\n\nNational Institute for Health and Care Excellence. Community pharmacy: promoting health and wellbeing. Evidence reviews for providing information on health and wellbeing. Evidence review 1. NICE Guideline NG102; 2018.\nAvailable here.  \n","This guideline is for community pharmacies, local pharmaceutical committees and pharmacy organisations, commissioners of health-promoting interventions including local authorities, clinical commissioning groups and NHS England. Local professional networks, health and wellbeing boards. It may also be relevant for private and voluntary sector organisations providing health-promoting services, people working in related services, for example GP practices and out-of-hours services, members of the public. ","This guideline covers how community pharmacies can help maintain and improve people’s physical and mental health and wellbeing, including people with a long-term condition. It aims to encourage more people to use community pharmacies by integrating them within existing health and care pathways and ensuring they offer standard services and a consistent approach. It requires a collaborative approach from individual pharmacies and their representatives, local authorities and other commissioners. The guideline makes recommendations on:\n\n - Health and wellbeing hub\n - Overarching principles of good practice\n - Awareness raising and providing information\n - Advice and education\n - Behavioural support\n - Referrals and signposting\n\nRecommendation 1.4 on advice and education states that when someone uses pharmacy services to manage a long-term condition, use this as an opportunity to advise them on how to improve their general health and wellbeing. For example, follow recommendations on advice and education in NICE guidelines on: hypertension in adults for people with, or at risk of, hypertension (see the sections on lifestyle interventions and patient education and adherence to treatment). \n\n"]
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[null,"National Institute for Health and Care Excellence. Community pharmacy: promoting health and wellbeing. Evidence reviews for providing information on health and wellbeing. Evidence review 2. NICE Guideline NG102; 2018.\nAvailable here.  \n\nNational Institute for Health and Care Excellence. Community pharmacy: promoting health and wellbeing. Evidence reviews for providing information on health and wellbeing. Evidence review 3. NICE Guideline NG102; 2018.\nAvailable here.  \n\nNational Institute for Health and Care Excellence. Community pharmacy: promoting health and wellbeing. Evidence reviews for providing information on health and wellbeing. Evidence review 4. NICE Guideline NG102; 2018.\nAvailable here.  "]
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[null,"Deiet"]
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[null,"Adolygiadau systemataidd"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Rees K et al. Vegan dietary pattern for the primary and secondary prevention of cardiovascular diseases. Cochrane Database of Systematic Reviews 2021, Issue 2. Art. No.: CD013501.\nAvailable here","Adults (≥ 18 years of age) from the general population and those at high risk of CVD to examine primary prevention, and those with established CVD to examine secondary prevention.","The authors included thirteen RCTs (38 papers, 7 trial registrations) and eight ongoing trials. \nThe authors conducted three main comparisons:\n1. Vegan dietary intervention versus no intervention or minimal intervention for primary prevention; 2. Vegan dietary intervention versus another dietary intervention for primary prevention; \n3. Vegan dietary intervention versus another dietary intervention for secondary prevention.\nMost trials contributed to primary prevention: comparisons 1 (four trials, 466 participants randomised) and comparison 2 (eight trials, 409 participants randomised). They included only one secondary prevention trial for comparison 3 (63 participants randomised).\nFor comparison 1, there was a lack of evidence for an effect with the vegan dietary intervention on systolic blood pressure (MD 0.94 mmHg, 95% CI −1.18 to 3.06; 3 trials, 374 participants) and diastolic blood pressure (MD−0.27 mmHg, 95% CI −1.67 to 1.12; 3 trials, 372 participants) (low-certainty evidence).\nFor comparison 2 the authors are very uncertain about any effect of the vegan dietary intervention on systolic blood pressure (MD 0.02 mmHg, 95% CI −3.59 to 3.62) or diastolic blood pressure (MD 0.63 mmHg, 95% CI −1.54 to 2.80; 5 trials,247 participants (very low-certainty evidence)).\nOnly one trial (63 participants) contributed to comparison 3, where there was a lack of evidence for an effect of the vegan dietary intervention on lipid levels or blood pressure compared to other dietary interventions (low- or very low-certainty evidence).","Studies were generally small with few participants contributing to each comparison group. None of the included studies report on CVD clinical events. There is currently insufficient information to draw conclusions about the effects of vegan dietary interventions on CVD risk factors. The eight ongoing studies identified will add to the evidence base, with all eight reporting on primary prevention. There is a paucity of evidence for secondary prevention."]
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[null,"Semlitsch T, et al. A. Long‐term effects of weight‐reducing diets in people with hypertension. Cochrane Database of Systematic Reviews 2021, Issue 2. Art. No.: CD008274. DOI: 10.1002/14651858.CD008274.pub4. \nAvailable here.","Adults with primary hypertension.","This second update of a systematic review first published in 2011 aimed to assess the long‐term effects of weight‐reducing diets in people with hypertension on all‐cause mortality, cardiovascular morbidity, and adverse events (including total serious adverse events, withdrawal due to adverse events, and total non‐serious adverse events). A secondary objective was to assess the long‐term effects of weight‐reducing diets in people with hypertension on change from baseline in systolic blood pressure, change from baseline in diastolic blood pressure, and body weight reduction.\nThis second review update did not reveal any new trials, so the number of included trials remains the same: eight RCTs involving a total of 2100 participants with high blood pressure and a mean age of 45 to 66 years. Mean treatment duration was 6 to 36 months. One RCT evaluated the effects of dietary weight loss on a combined endpoint consisting of the necessity of reinstating antihypertensive therapy and severe cardiovascular complications. In this RCT, weight‐reducing diet lowered the endpoint compared to no diet: hazard ratio 0.70 (95% confidence interval (CI) 0.57 to 0.87). The certainty of the evidence was low for a blood pressure reduction in participants assigned to weight‐loss diets as compared to controls: systolic blood pressure: mean difference (MD) −4.5 mm Hg (95% CI −7.2 to −1.8 mm Hg) (3 studies, 731 participants), and diastolic blood pressure: MD −3.2 mm Hg (95% CI −4.8 to −1.5 mm Hg) (3 studies, 731 participants). The authors judged the certainty of the evidence to be high for weight reduction in dietary weight loss groups as compared to controls: MD −4.0 kg (95% CI −4.8 to −3.2) (5 trials, 880 participants). Two trials used withdrawal of antihypertensive medication as their primary outcome. Even though the authors did not consider this a relevant outcome for our review, the results of these RCTs strengthen the finding of a reduction of blood pressure by dietary weight‐loss interventions.","In this second update, the conclusions remain unchanged, as the authors found no new trials. In people with primary hypertension, weight‐loss diets reduced body weight and blood pressure, but the magnitude of the effects are uncertain due to the small number of participants and studies included in the analyses. Whether weight loss reduces mortality and morbidity is unknown. No useful information on adverse effects was reported in the relevant trials."]
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[null,"Graudal NA et al. Effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride. Cochrane Database of Systematic Reviews 2020, Issue 12. Art. No.: CD004022. DOI: 10.1002/14651858.CD004022.pub5.\nAvailable here","The authors compared normotensive and hypertensive populations in White, Black and Asian populations; mostly adults some adolescents.","This update of a 2017 Cochrane review (first published 2003) aimed to assess the effects of sodium reduction on blood pressure, and on potential side‐effects (hormones and lipids). Since the first review in 2003 the number of included references has increased from 96 to 195 (174 were in white participants). As a previous study found different blood pressure outcomes in black and white study populations, the authors stratified the BP outcomes by race.\n\nThe effect of sodium reduction (from 203 to 65 mmol/day) on BP in white participants was as follows: Normal blood pressure: SBP: mean difference (MD) ‐1.14 mmHg (95% confidence interval (CI): ‐1.65 to ‐0.63), 5982 participants, 95 trials; DBP: MD + 0.01 mmHg (95% CI: ‐0.37 to 0.39), 6276 participants, 96 trials. Hypertension: SBP: MD ‐5.71 mmHg (95% CI: ‐6.67 to ‐4.74), 3998 participants,88 trials; DBP: MD ‐2.87 mmHg (95% CI: ‐3.41 to ‐2.32), 4032 participants, 89 trials (all high‐quality evidence).\n\nThe effect of sodium reduction (from 195 to 66 mmol/day) on BP in black participants was as follows: Normal blood pressure: SBP: mean difference (MD) ‐4.02 mmHg (95% CI:‐7.37 to ‐0.68); DBP: MD ‐2.01 mmHg (95% CI:‐4.37, 0.35), 253 participants, 7 trials. Hypertension: SBP: MD ‐6.64 mmHg (95% CI:‐9.00, ‐4.27); DBP: MD ‐2.91 mmHg (95% CI:‐4.52, ‐1.30), 398 participants, 8 trials (low‐quality evidence).\n\nThe effect of sodium reduction (from 217 to 103 mmol/day) on BP in Asian participants was as follows: Normal blood pressure: SBP: mean difference (MD) ‐1.50 mmHg (95% CI: ‐3.09, 0.10); DBP: MD ‐1.06 mmHg (95% CI:‐2.53 to 0.41), 950 participants, 5 trials. Hypertension: SBP: MD ‐7.75 mmHg (95% CI:‐11.44, ‐4.07); DBP: MD ‐2.68 mmHg (95% CI: ‐4.21 to ‐1.15), 254 participants, 8 trials (moderate‐low‐quality evidence).\n","In white participants, sodium reduction in accordance with the public recommendations resulted in mean arterial pressure (MAP) decrease of about 0.4 mmHg in participants with normal blood pressure and a MAP decrease of about 4 mmHg in participants with hypertension. Weak evidence indicated that these effects may be a little greater in black and Asian participants. The effects of sodium reduction on potential side effects (hormones and lipids) were more consistent than the effect on BP, especially in people with normal BP."]
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[null,"Hooper  L, et al. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database of Systematic Reviews 2020, Issue 8. Art. No.: CD011737. DOI: 10.1002/14651858.CD011737.pub3. Available here.","Adults (18 years or older), with and without cardiovascular disease.","The authors sought to assess the effect of reducing saturated fat intake and replacing it with carbohydrate (CHO), polyunsaturated (PUFA), monounsaturated fat (MUFA) and/or protein on mortality and cardiovascular morbidity.\nThey included trials that used a variety of interventions from providing all food to advice on reducing saturated fat. The included long‐term trials suggested that reducing dietary saturated fat reduced the risk of combined cardiovascular events by 17% (risk ratio (RR) 0.83; 95% confidence interval (CI) 0.70 to 0.98, 12 trials, 53,758 participants of whom 8% had a cardiovascular event, I² = 67%, GRADE moderate‐quality evidence). Meta‐regression suggested that greater reductions in saturated fat (reflected in greater reductions in serum cholesterol) resulted in greater reductions in risk of CVD events, explaining most heterogeneity between trials. The number needed to treat for an additional beneficial outcome (NNTB) was 56 in primary prevention trials, so 56 people need to reduce their saturated fat intake for four years for one person to avoid experiencing a CVD event. In secondary prevention trials, the NNTB was 53. Subgrouping did not suggest significant differences between replacement of saturated fat calories with polyunsaturated fat or carbohydrate, and data on replacement with monounsaturated fat and protein was very limited. \n\nThe authors found little or no effect of reducing saturated fat on all‐cause mortality (RR 0.96; 95% CI 0.90 to 1.03; 11 trials, 55,858 participants) or cardiovascular mortality (RR 0.95; 95% CI 0.80 to 1.12, 10 trials, 53,421 participants), both with GRADE moderate‐quality evidence. \n\nThere was little or no effect of reducing saturated fats on non‐fatal myocardial infarction (RR 0.97, 95% CI 0.87 to 1.07) or CHD mortality (RR 0.97, 95% CI 0.82 to 1.16, both low‐quality evidence), but effects on total (fatal or non‐fatal) myocardial infarction, stroke and CHD events (fatal or non‐fatal) were all unclear as the evidence was of very low quality. There was little or no effect on cancer mortality, cancer diagnoses, diabetes diagnosis, HDL cholesterol, serum triglycerides or blood pressure, and small reductions in weight, serum total cholesterol, LDL cholesterol and BMI. There was no evidence of harmful effects of reducing saturated fat intakes.","The findings of this updated review suggest that reducing saturated fat intake for at least two years causes a potentially important reduction in combined cardiovascular events. Replacing the energy from saturated fat with polyunsaturated fat or carbohydrate appear to be useful strategies, while effects of replacement with monounsaturated fat are unclear. \nThe reduction in combined cardiovascular events resulting from reducing saturated fat did not alter by study duration, sex or baseline level of cardiovascular risk, but greater reduction in saturated fat caused greater reductions in cardiovascular events."]
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[null,"Ellwood, L et al. Effects of flavonoid-rich fruits on hypertension in adults: a systematic review. JBI Database of Systematic Reviews and Implementation Reports: October 2019 - Volume 17 - Issue 10 - p 2075-2105 doi: 10.11124/JBISRIR-D-19-00050\nAvailable here","Participants aged 18 years and over with primary, secondary or malignant hypertension.","Six trials investigated the effect of the flavonoid intervention on blood pressure within four weeks. Meta-analysis of four of the trials demonstrated no effect of flavonoids on systolic or diastolic blood pressure when compared to placebo (systolic mean difference = −1.02, 95% confidence interval [CI] −3.12, 1.07; p = 0.34, I2 = 0%; diastolic mean difference = −0.90, 95% CI −2.10, 0.31; p = 0.15, I2 = 0%). Similarly, pooled results from two crossover RCTs with two-timed dosed interventions in a 24-hour period demonstrated no effect on a reduction in diastolic blood pressure (p = 0.38) but did reveal evidence of a reduction in systolic blood pressure (p = 0). Six trials assessed blood pressure following the flavonoid intervention at more than four weeks follow-up. Meta-analysis of five of the trials demonstrated evidence of no effect on either systolic blood pressure (mean difference = −0.95, 95% CI −3.58, 1.68; p = 0.478, I2 = 0%) or diastolic blood pressure (mean difference = 0.86, 95%CI −1.11, 2.82; p = 0.393, I2 = 0%).","The findings of this systematic review should be interpreted with caution, given that the results are obtained from single-center trials with small sample sizes. Flavonoids have no effect on systolic and diastolic blood pressure. \nFurther robust RCTs using sample sizes based on power calculations are needed to provide evidence for the use of flavonoid-rich fruits for the management of hypertension."]
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[null,"Remington, J and Winters, K. Effectiveness of dietary inorganic nitrate for lowering blood pressure in hypertensive adults: a systematic review, JBI Database of Systematic Reviews and Implementation Reports: March 2019 - Volume 17 - Issue 3 - p 365-389 doi: 10.11124/JBISRIR-2017-003842.\nAvailable here","Adults aged 18 years and over, with blood pressure greater than 120/80 mmHg, undergoing interventions focusing on the effects of inorganic nitrate on blood pressure.","Twelve papers were included in the systematic review with a total of 321 participants. Ten were randomized controlled trials and two were quasi-experimental studies. All participants had baseline blood pressures greater than 120/80 mmHg. Some studies included participants with comorbidities such as diabetes or heart failure with preserved ejection fraction. Inorganic nitrate was administered multiple ways throughout the studies including the following: beetroot juice, beetroot gel, nitric oxide lozenge, high nitrate diet, and raw and cooked beet juice. Doses and treatment intervals varied. Some studies included exercise as part of the intervention protocol.\n\nMeta-analysis was not conducted due to heterogeneity that existed within the studies. Blood pressure was measured in multiple settings by manual, digital or ambulatory means. The noted outcome patterns were as follows: no change in systolic blood pressure and diastolic blood pressure, decrease in systolic blood pressure and diastolic blood pressure, or decrease in systolic blood pressure with no change in diastolic blood pressure. Possible reasons for the diverse findings include the following: age, comorbidities, use of antihypertensives by participants; source and dose of nitrate; and intervention and follow-up time frames.","There is insufficient evidence to support or refute the use of inorganic nitrate for any effect on blood pressure at this time. Therefore, there is no concrete base for the development of practice guidelines until stronger evidence becomes available. The gaps in the literature along with the study limitations identified necessitate the need for more research on inorganic nitrate and how it relates to blood pressure."]
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[null,"Rees  K, et al. Mediterranean‐style diet for the primary and secondary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2019, Issue 3. Art. No.: CD009825. DOI: 10.1002/14651858.CD009825.pub3\nAvailable here.","Healthy adults and adults at high risk of cardiovascular disease (CVD) (for primary prevention). Adults with established CVD (secondary prevention).  ","30 studies were included in the overall review. The results for blood pressure outcomes are reported below. \n\n1. Mediterranean dietary intervention versus no intervention or minimal intervention for primary prevention\n\nTwo trials (269 participants) measured SBP and reported data that could be used in meta‐analyses. There was moderate‐quality evidence of a reduction in SBP with the intervention (MD ‐2.99 mm Hg, 95% CI ‐3.45 to ‐2.53, I² = 0%). \n\nOne trial measured SBP but did not provide data in a useable format for meta‐analyses. Preliminary analysis of an ongoing study reported a change in SBP of 2.6 mm Hg between baseline and follow‐up of six months in 181 patients with metabolic disease following Mediterranean dietary advice, with a difference between the intervention and control group who received no advice of ‐5.1% (p< 0.05). \n\nTwo trials (269 participants) measured DBP and reported data that could be used in meta‐analyses. There was moderate‐quality evidence of a reduction in DBP with the intervention (MD ‐2.0 mm Hg, 95% CI ‐2.29 to ‐1.71, I² = 0%).\n\n \n\n\n","Despite the relatively large number of studies included in this review, there is still some uncertainty regarding the effects of a Mediterranean‐style diet on clinical endpoints and CVD risk factors for both primary and secondary prevention. The quality of evidence for the modest benefits on CVD risk factors in primary prevention is low or moderate, with a small number of studies reporting minimal harms. There is a paucity of evidence for secondary prevention. The ongoing studies may provide more certainty in the future. \n\nAuthors' implications for practice:\nDespite the large number of trials included in the review there is still uncertainty regarding the effects of a Mediterranean‐style diet on clinical endpoints and cardiovascular disease (CVD) risk factors for both primary and secondary prevention from current clinical trial evidence. However, based on supportive observational evidence, positive findings from early clinical trials and the biological plausibility of several mechanisms to explain the beneficial effect of the Mediterranean diet, it has become a popular dietary pattern. \n\nIndeed, some aspects and components of a Mediterranean‐style diet are already included in scientific and clinical guidelines to promote healthy eating and prevent cardiovascular disease, such as the DASH diet, the 2015 Dietary Guidelines for Americans, the Healthy Eating Plate, and the Eatwell guide. \n"]
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[null,null,null,"2. Mediterranean dietary intervention versus another dietary intervention for primary prevention\n\nFour trials (448 participants) measured SBP and provided data that could be pooled in a meta‐analysis. For the PREDIMED trial, blood pressure was analysed in multivariate analyses and these are reported separately below. There was low‐quality evidence that the Mediterranean diet had little or no effect on SBP levels (MD ‐1.5 mm Hg, 95% CI ‐3.92 to 0.92, I² = 16%). \n\nFour trials (448 participants) measured DBP and provided data that could be pooled in a meta‐analysis. For the PREDIMED trial, blood pressure was analysed in multivariate analyses and these are reported separately below. There was low‐quality evidence that the Mediterranean diet had little or no effect on DBP levels (MD ‐0.26 mm Hg, 95% CI ‐2.41 to 1.9, I² = 37%) (Analysis 2.14). \n\nThe PREDIMED study used multivariate adjusted analyses controlling for centre, age, sex, diabetes, baseline blood pressure and antihypertensive drugs. Mean differences in SBP changes (mm Hg) in the two intervention groups versus the control group after a median follow‐up of 3.8 years were 0.39 (‐0.48 to 1.26) for PREDIMED + extra virgin olive oil (EVOO) versus control (p=0.38) and ‐ 0.72 (‐1.58 to 0.13) for PREDIMED + nuts versus control (p= 0.10). Mean differences in DBP changes (mm Hg) in the two intervention groups versus the control group after a median follow‐up of 3.8 years were ‐1.53 (‐2.01 to ‐1.04) for PREDIMED + EVOO versus control (p < 0.001) and ‐0.65 (‐1.15 to ‐0.15) for PREDIMED + nuts versus control (p = 0.01). \n"]
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[null,null,null,"3. Mediterranean dietary intervention versus usual care for secondary prevention\n\nOne trial (556 participants) measured blood pressure (The Lyon Diet Heart Study). There was very low-quality evidence that the Mediterranean diet produced little or no effect on either SBP (MD -2.00 mm Hg, 95% CI -5.29 to 1.29) or DBP (MD -1.00 mm Hg, 95% CI -4.29 to 2.29). "]
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[null,null,null,"4. Mediterranean dietary intervention versus other dietary intervention for secondary prevention\n\nFour studies report blood pressure for this comparison group with data in a useable format for meta‐analyses. Two of the studies have been excluded in sensitivity analyses from all main analyses due to published concerns regarding the reliability of the data. In the remaining two studies, there was very low‐quality evidence of little or no effect of the Mediterranean diet on SBP levels (MD 1.76 mm Hg, 95% CI ‐2.80 to 6.33, I² = 0%) or DBP levels (MD 0.98 mm Hg, 95% CI ‐1.97 to 3.93, I² = 0%). \n\nIn a further study and preliminary analysis of the AUSMED trial the authors report that compared to the low‐fat diet, the MedDiet did not change the blood pressure profile (p > 0.05). The variables were not measured in a later analysis of the full cohort. \n"]
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[null,"Ried  K, Fakler  P, Stocks  NP. Effect of cocoa on blood pressure. Cochrane Database of Systematic Reviews 2017, Issue 4. Art. No.: CD008893. DOI: 10.1002/14651858.CD008893.pub3.\nAvailable here.","Adults (no further restrictions)","This Cochrane review aimed to assess the effects on blood pressure of chocolate or cocoa products versus low‐flavanol products or placebo in adults with or without hypertension when consumed for two weeks or longer.\n\nThirty‐five trials (including 40 treatment comparisons) met the inclusion criteria. Of these, 17 trials were added (20 treatment comparisons) to the 18 trials (20 treatment comparisons) in the previous version of this updated review. \n\nTrials provided participants with 30 to 1218 mg of flavanols (mean = 670 mg) in 1.4 to 105 grams of cocoa products per day in the active intervention group. The control group received either a flavanol‐free product (n = 26 treatment comparisons) or a low‐flavanol‐containing cocoa powder (range 6.4 to 88 mg flavanols (mean = 55 mg, 13 treatment comparisons; 259 mg, one trial). \n\nMeta‐analyses of the 40 treatment comparisons involving 1804 mainly healthy participants revealed a small but statistically significant blood pressure‐reducing effect of flavanol‐rich cocoa products compared with control in trials of two to 18 weeks duration (mean nine weeks): Mean difference SBP (95% confidence interval (CI): ‐1.76 (‐3.09 to ‐0.43) mm Hg, p = 0.009, n = 40 treatment comparisons, 1804 participants; Mean difference DBP (95% CI): ‐1.76 (‐2.57 to ‐0.94) mm Hg, p < 0.001, n = 39 treatment comparisons, 1772 participants. \n\nBaseline blood pressure may play a role in the effect of cocoa on blood pressure. While SBP was reduced significantly by 4 mm Hg in hypertensive people (n = 9 treatment comparisons, 401 participants), and tended to be lowered in prehypertensive people (n= 8 treatment comparisons, 340 participants), there was no significant difference in normotensive people (n = 23 treatment comparisons, 1063 participants); however, the test for subgroup differences was of borderline significance (p = 0.08; I2 = 60%), requiring further research to confirm the findings. \n\n\n","This review provides moderate‐quality evidence that flavanol‐rich chocolate and cocoa products cause a small (2 mm Hg) blood pressure‐lowering effect in mainly healthy adults in the short term. \n\nThese findings are limited by the heterogeneity between trials, which could not be explained by prespecified subgroup analyses, including blinding, flavanol content of the control groups, age of participants, or study duration. However, baseline blood pressure may play a role in the effect of cocoa on blood pressure; subgroup analysis of trials with (pre)hypertensive participants revealed a greater blood pressure‐reducing effect of cocoa compared to normotensive participants with borderline significance. \n\nLong‐term trials investigating the effect of cocoa on clinical outcomes are also needed to assess whether cocoa has an effect on cardiovascular events and to assess potential adverse effects associated with chronic ingestion of cocoa products. \n"]
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[null,"Kelly SAM et al. Whole grain cereals for the primary or secondary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2017, Issue 8. Art. No.: CD005051. DOI: 10.1002/14651858.CD005051.pub3.\nAvailable here.","Healthy adults, those at increased risk of CVD, or those who have been previously diagnosed with CVD. ","The aim of this systematic review was to assess the effect of whole grain foods or diets on total mortality, cardiovascular events, and cardiovascular risk factors (blood lipids, blood pressure) in healthy people or people who have established cardiovascular disease or related risk factors, using all eligible RCTs.\n\nNine RCTs randomising a total of 1414 participants (age range 24 to 70; mean age 45 to 59, where reported) to whole grain versus lower whole grain or refined grain control groups were included. Blood pressure change was a secondary outcome in this review and the results are reported below:\n\nEight studies reported SBP and data from seven studies (eight comparators) could be summarised in a meta‐analysis. The pooled analysis showed no effect on SBP (MD 0.04, 95% CI ‐1.67 to 1.75; 768 participants). There was no substantial heterogeneity. In the study that could not be included in the meta‐analysis, there were no effects of whole grain foods compared with the control group. \n\nEight studies reported DBP, and data from seven studies (eight comparators) could be summarised in a meta‐analysis. The pooled analysis showed no effect on DBP (MD 0.16, 95% CI ‐0.89 to 1.21; 768 participants). There was no heterogeneity. In the study that could not be included in the meta‐analysis, there were no effects of whole grain foods compared with the control group. \n\n\n\n","There is insufficient evidence from RCTs of an effect of whole grain diets on cardiovascular outcomes or on major CVD risk factors such as blood lipids and blood pressure. Trials were at unclear or high risk of bias with small sample sizes and relatively short‐term interventions, and the overall quality of the evidence was low. There is a need for well‐designed, adequately powered RCTs with longer durations assessing cardiovascular events as well as cardiovascular risk factors. "]
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[null,"Semlitsch  T, et al. Long‐term effects of weight‐reducing diets in people with hypertension. Cochrane Database of Systematic Reviews 2016, Issue 3. Art. No.: CD008274. DOI: 10.1002/14651858.CD008274.pub3.\nAvailable here. ","Adults with primary hypertension. ","This Cochrane review update aimed to assess the long-term effects of weight-reducing diets in people with hypertension on change from baseline in SBP, change from baseline in DBP and body weight reduction. \n\nThe update did not reveal any new studies, so the number of included studies remained the same: eight studies involving a total of 2100 participants with high blood pressure and a mean age of 45 to 66 years. Mean treatment duration was six to 36 months. Risk of bias was judged as unclear or high for all but two trials. No study included mortality as a predefined outcome. \n\nThere was low‐quality evidence for a blood pressure reduction in participants assigned to weight loss diets as compared to controls: SBP: mean difference (MD) ‐4.5 mm Hg (95% CI ‐7.2 to ‐1.8 mm Hg) (n=3 studies), and DBP: MD ‐3.2 mm Hg (95% CI ‐4.8 to ‐1.5 mm Hg) (n=3 studies). There was moderate‐quality evidence for weight reduction in dietary weight loss groups as compared to controls: MD ‐4.0 kg (95% CI ‐4.8 to ‐3.2) (n=5 studies). ","In this update, the conclusions remain the same, as we found no new trials. In people with primary hypertension, weight loss diets reduced body weight and blood pressure, however the magnitude of the effects are uncertain due to the small number of participants and studies included in the analyses. Whether weight loss reduces mortality and morbidity is unknown. No useful information on adverse effects was reported in the relevant trials. "]
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[null,"Hartley  L, et al. Dietary fibre for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2016, Issue 1. Art. No.: CD011472. DOI: 10.1002/14651858.CD011472.pub2.\nAvailable here. ","Adults at risk of CVD or those from the general population","This Cochrane review aimed to determine the effectiveness of dietary fibre for the primary prevention of CVD. \n\nTwenty-three RCTs (1513 participants randomised) were included in the full review.  The risk of bias was unclear for most studies and studies had small sample sizes. Few studies had an intervention duration of longer than 12 weeks. There was a wide variety of fibre sources used, with little similarity between groups in the choice of intervention.  Change in blood pressure was a secondary outcome of the review, the results are reported below:\n\nEight studies reported SBP and could be summarised in a meta‐analysis (10 comparisons). The pooled analysis showed a reduction in SBP with the intervention but this did not reach statistical significance (MD ‐1.92 mm Hg, 95% CI ‐4.02 to 0.19; p = 0.07). There was significant heterogeneity (p = 0.0006; I2 = 69%) and results were pooled with a random‐effects model. \n\nEight studies reported DBP and could be summarised in a meta‐analysis (10 comparisons). The pooled analysis showed a significant difference between comparison groups favouring fibre (MD ‐1.77 mm Hg, 95% CI ‐2.61 to ‐0.92; p < 0.0001). There was no significant heterogeneity (P = 0.37; I2 = 7%). ","Studies were short term and therefore did not report on the primary outcomes for the review, CVD clinical events. The pooled analyses for CVD risk factors suggest reductions in total cholesterol and LDL cholesterol with increased fibre intake, and reductions in DBP. There authors found no obvious effects of subgroup analyses by type of intervention or fibre type but the number of studies included in each of these analyses were small. Risk of bias was unclear in the majority of studies and high for some quality domains so results need to be interpreted cautiously. The review authors state that there is a need for longer term, well‐conducted RCTs to determine the effects of fibre type (soluble versus insoluble) and administration (supplements versus foods) on CVD events and risk factors for the primary prevention of CVD. "]
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[null,"Martin  N, et al. Nut consumption for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD011583. DOI: 10.1002/14651858.CD011583.pub2.\nAvailable here. ","Healthy adults or adults at moderate and high risk of CVD. ","This Cochrane review aimed to determine the effectiveness of nut consumption for the primary prevention of CVD. \n\nFive trials (435 participants randomised) and one ongoing trial were included in the review. One study is awaiting classification. All trials examined the provision of nuts to increase consumption rather than dietary advice. Blood pressure change was a secondary outcome of the review. The results are reported below:\n\nThree trials (267 participants) measured mean change in systolic and DBP (mm Hg) from baseline to last follow‐up, which was three months in two trials and 12 weeks for one trial (with two trial arms). For SBP heterogeneity was substantial between trials (I² = 55%) using a random‐effects model. There was no statistically significant effect of nut consumption on SBP (MD 3.22 mm Hg, 95% CI ‐2.70 to 9.14; p = 0.29). However, one trial was a clear outlier with an extremely large reduction in SBP in the control arm during the trial period of 14 mm Hg. Excluding this trial from the sensitivity analysis gave a MD of ‐0.28 mm Hg (95% CI ‐5.79 to 5.23; p = 0.92). \n\nFor DBP, because of the substantial heterogeneity (I² = 87%) the pooled effect estimate was suppressed and results from individual trials are plotted. One trial showed a statistically significant reduction, one trial with two arms showed a statistically significant increase in DBP with the intervention and the remaining trial showed no effect of the intervention. \n","The review authors conclude that currently there is a lack of evidence for the effects of nut consumption on CVD, clinical events in primary prevention and very limited evidence for the effects on CVD risk factors. No conclusions can be drawn and further high quality longer term and adequately powered trials are needed to answer the review question. "]
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[null,"Bloomfield HE et al. Benefits and Harms of the Mediterranean Diet Compared to Other Diets. Minneapolis: Veterans Affairs Evidence-based synthesis program; 2015. \nAvailable here. ","Adults (18+) not pregnant or lactating and not hospitalised or institutionalised. ","This systematic review aimed to assess whether the Mediterranean diet is more effective than other diets in preventing death or the development of type 2 diabetes mellitus, cardiovascular disease, cancer, hypertension, cognitive impairment, or kidney disease. \n\nThe review included 93 papers reporting on 55 studies published between 1990 and 2015. The authors did not find any studies reporting on the Mediterranean diet for preventing or treating hypertension. ","In this systematic review and meta-analysis of 55 published studies we identified a single primary prevention trial which found that consumption of a Mediterranean diet was associated with a significant reduction in major cardiac events, new onset T2DM, and breast cancer incidence. For secondary prevention, data from two trials indicate that assignment to a Mediterranean diet reduces incidence of myocardial infarction but not other cardiovascular outcomes. Cohort studies indicate that conformity to a Mediterranean diet pattern is associated with significant reduction in total cancer incidence, total cancer mortality and colorectal cancer incidence. These associations have not been confirmed in RCTs.  The available data on dietary adherence suggest that sustained increases in consumption of fruits and vegetables and grains can be achieved with labour-intensive behavioral interventions in select populations."]
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[null,"Canadian Agency for Drugs and Technologies in Health\nObesity Management Interventions Delivered in Primary Care for Patients with Hypertension or Cardiovascular Disease: A Review of Clinical Effectiveness \n2014 Jul 9. \nAvailable here\n","Adults with body-mass-index (BMI) of 30 or higher who have hypertension or cardiovascular disease (CVD) or both.","Greater weight loss correlated positively with greater reductions in blood pressure and cardiovascular risk factors regardless of which weight loss intervention was used. Dietary only interventions achieved greater initial weight loss than physical activity only interventions with the greatest weight loss occurring around 6 months. However, only lifestyle interventions that combine dietary changes and physical activity have been shown to produce significant differences in weight loss beyond 12 months. \n\nA lifestyle intervention and comprehensive metabolic risk factor management program resulted in weight loss associated with a substantial reduction in the symptom burden and symptom severity of atrial fibrillation. \n\nMotivational Interviewing (MI) was effective in bringing about long-term improvements in walking, and cholesterol levels, and was particularly effective for patients with elevated baseline levels of CVD risk factors. \n\nIn overweight or obese individuals at increased cardiovascular risk, Mediterranean diets appear to be more effective than low-fat diets in inducing clinically relevant long-term changes in cardiovascular risk factors and inflammatory markers, with evidence from one study demonstrating a lasting benefit of Mediterranean diets for 2 years after the beginning of the diet.","The pharmacological weight loss intervention studies demonstrated significantly greater weight reductions in obese patient compared to lifestyle interventions alone. \n\nLifestyle interventions for weight loss that combined diet and exercise were more successful at achieving targeted weight loss goals than diet-only interventions or physical activity-only intervention. Also, MI counselling intervention was demonstrated to be an effective tool to promote lifestyle changes leading to greater weight loss than a one-time provision of written information about diet and exercise. \n\nSignificant weight loss (≥5%) was associated with health benefits including reduction in blood pressure, both systolic and diastolic, as well as reductions in cardiovascular risk factors, including hyperglycemia, and dyslipidemia, and reduced use of concomitant medications. The degree of health benefits positively correlated with the degree of weight loss regardless of the intervention used. \n\nWith regards to dietary weight loss programs, evidence from a meta-analysis indicated that Mediterranean diets appear to be more effective than low-fat diets in inducing clinically relevant long-term changes in cardiovascular risk factors and inflammatory markers."]
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[null,"He  FJ, et al. Effect of longer‐term modest salt reduction on blood pressure. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD004937. DOI: 10.1002/14651858.CD004937.pub2.\nAvailable here. ","Adults with normal or raised blood pressure. ","This Cochrane review aimed to assess (1) the effect of long-term modest reduction in salt intake on BP and whether there was a dose-response relationship; (2) the effect on BP by sex and ethnic group; (3) the effect on plasma renin activity, aldosterone, noradrenaline, adrenaline, cholesterol, low‐density lipoprotein (LDL), high‐density lipoprotein (HDL) and triglycerides. \n\nThirty‐four trials (3,230 participants) were included. Meta‐analysis showed that the mean change in urinary sodium (reduced salt vs usual salt) was ‐75 mmol/24‐h (equivalent to a reduction of 4.4 g/d salt), the mean change in BP was ‐4.18 mm Hg (95% CI: ‐5.18 to ‐3.18, I2=75%) for systolic and ‐2.06 mm Hg (95% CI: ‐2.67 to ‐1.45, I2=68%) for diastolic BP. Meta‐regression showed that age, ethnic group, BP status (hypertensive or normotensive) and the change in 24‐h urinary sodium were all significantly associated with the fall in systolic BP, explaining 68% of the variance between studies. A 100 mmol reduction in 24 hour urinary sodium (6 g/day salt) was associated with a fall in systolic BP of 5.8 mm Hg (95%CI: 2.5 to 9.2, p=0.001) after adjusting for age, ethnic group and BP status. For diastolic BP, age, ethnic group, BP status and the change in 24‐h urinary sodium explained 41% of the variance between studies. Meta‐analysis by subgroup showed that, in hypertensives, the mean effect was ‐5.39 mm Hg (95% CI: ‐6.62 to ‐4.15, I2=61%) for systolic and ‐2.82 mm Hg (95% CI: ‐3.54 to ‐2.11, I2=52%) for diastolic BP. In normotensives, the mean effect was ‐2.42 mm Hg (95% CI: ‐3.56 to ‐1.29, I2=66%) for systolic and ‐1.00 mm Hg (95% CI: ‐1.85 to ‐0.15, I2=66%) for diastolic BP. Further subgroup analysis showed that the decrease in systolic BP was significant in both whites and blacks, men and women. Meta‐analysis of hormone and lipid data showed that the mean effect was 0.26 ng/ml/hr (95% CI: 0.17 to 0.36, I2=70%) for plasma renin activity, 73.20 pmol/l (95% CI: 44.92 to 101.48, I2=62%) for aldosterone, 31.67 pg/ml (95% CI: 6.57 to 56.77, I2=5%) for noradrenaline, 6.70 pg/ml (95% CI: ‐0.25 to 13.64, I2=12%) for adrenaline, 0.05 mmol/l (95% CI: ‐0.02 to 0.11, I2=0%) for cholesterol, 0.05 mmol/l (95% CI: ‐0.01 to 0.12, I2=0%) for LDL, ‐0.02 mmol/l (95% CI: ‐0.06 to 0.01, I2=16%) for HDL, and 0.04 mmol/l (95% CI: ‐0.02 to 0.09, I2=0%) for triglycerides.","A modest reduction in salt intake for four or more weeks causes significant and, from a population viewpoint, important falls in BP in both hypertensive and normotensive individuals, irrespective of sex and ethnic group. With salt reduction, there is a small physiological increase in plasma renin activity, aldosterone and noradrenaline. There is no significant change in lipid levels. These results provide further strong support for a reduction in population salt intake. This will likely lower population BP and, thereby, reduce cardiovascular disease. Additionally, our analysis demonstrates a significant association between the reduction in 24‐h urinary sodium and the fall in systolic BP, indicating the greater the reduction in salt intake, the greater the fall in systolic BP. The current recommendations to reduce salt intake from 9‐12 to 5‐6 g/d will have a major effect on BP, but are not ideal. A further reduction to 3 g/d will have a greater effect and should become the long term target for population salt intake."]
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[null,"Desroches  S, et al. Interventions to enhance adherence to dietary advice for preventing and managing chronic diseases in adults. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD008722. DOI: 10.1002/14651858.CD008722.pub2\nAvailable here. ","Adults participating in chronic disease prevention or chronic disease management studies involving dietary advice. ","This Cochrane review aimed to assess the effects of interventions for enhancing adherence to dietary advice for preventing and managing chronic diseases in adults. \n\nThirty-eight studies were included in the review involving 9,445 participants. Five studies addressed the management of hypertension:\n\nOne study assessed the effects of telephone follow‐up on: adherence to a sodium‐restricted diet; fat intake and fruit and vegetable intake, in clients with hypertension. The study authors reported no differences in diet adherence between the intervention group and the control group at eight weeks. However, a greater decrease in systolic and DBP was observed in the intervention group compared to the control group as well as a greater increase in exercise adherence. \n\nAnother study also evaluated the effects of telephone follow‐up on adherence to a sodium‐restricted diet in clients with hypertension. The authors reported that a higher proportion of clients adhered to the sodium‐restricted diet at 24 weeks in the intervention group compared to the control group, but the difference was no longer significant at 36 weeks. No differences were found in systolic and DBP between groups. The authors also noted no difference in non‐adherence to alcohol intake at 24 and 36 weeks between groups.\n\nOne study assessed the effects of feedback using self‐monitoring of urine chloride concentration on adherence to a sodium‐restricted diet in clients with hypertension. No difference was reported in adherence to the sodium‐restricted diet or in blood pressure between the intervention group and the control group at one and three months.\n\nOne study evaluated the effects of wheels and bar charts displaying cognitive representations of the DASH diet as a nutritional tool on adherence to the DASH diet in clients with hypertension compared to a control group. The study authors reported results grouped for both groups, making comparison between groups impossible.\n\nThe final study assessed the effectiveness of an intervention using telephone follow‐up combined with motivational interviewing, comparing two interventions in clients with hypertension with a usual care group: 1) simultaneous behaviour change (stop smoking, reduce dietary sodium level and increase physical activity) and 2) sequential behaviour change (stop smoking, then reduce dietary sodium levels and finally increase physical activity). A higher proportion of clients adhered to the sodium‐restricted diet in the simultaneous group, compared to the sequential intervention and the usual care group at six months, but no difference was observed at 18 months. No difference was reported for blood pressure between groups.","The authors conclude that there is a need for further, long‐term, good‐quality studies using more standardised and validated measures of adherence to identify the interventions that should be used in practice to enhance adherence to dietary advice in the context of a variety of chronic diseases."]
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[null,"Hartley  L, et al. Green and black tea for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD009934. DOI: 10.1002/14651858.CD009934.pub2.\nAvailable here. ","Healthy adults or those at high risk of CVD. ","This Cochrane review aimed to determine the effects of green and black tea on the primary prevention of CVD. \n\nEleven RCTs (821 participants), two trials awaiting classification and one ongoing trial were identified. Seven trials examined a green tea intervention and four examined a black tea intervention. Dosage and form of both green and black tea differed between trials. The ongoing trial is examining the effects of green tea powder capsules. Blood pressure was a secondary outcome of the review, the results are reported below:\n\nBlack tea:\nTwo trials examined the effect of black tea on blood pressure. The meta‐analysis (123 participants) showed a statistically significant reduction in SBP (MD ‐1.85 mm Hg, 95% CI ‐3.21 to ‐0.48). DBP (123 participants) was also reduced with the black tea intervention, however, this result did not reach statistical significance (MD ‐1.27 mm Hg, 95% CI ‐3.06 to 0.53). \n\nGreen tea:\nThree trials examining green tea measured blood pressure but one did not provide any individual group data and could not be included in a meta‐analysis. The pooled analysis showed a statistically significant reduction in SBP (167 participants) (MD ‐3.18 mm Hg, 95% CI ‐5.25 to ‐1.11) and DBP (167 participants) (MD ‐3.42, 95% CI ‐4.54 to ‐2.30) in the green tea group. The trial not included in the meta‐analysis showed no significant change in blood pressure in either the tea (SBP change 1.10%, DBP change ‐7.20%) or control group (SBP decrease 0%, DBP decrease 1.10%). \n\nAll tea (green and black):\nFive trials (three using green tea and two using black tea) measured blood pressure. Only four of these contributed to the meta‐analysis as one trial did not report individual group data. The meta‐analysis showed a statistically significant reduction in SBP (290 participants) (MD ‐2.25 mm Hg, 95% CI ‐3.39 to ‐1.11) and DBP (290 participants) (MD ‐2.81 mm Hg, 95% CI ‐3.77 to ‐1.86) with the tea intervention. ","There are very few long‐term studies to date examining green or black tea for the primary prevention of CVD. The limited evidence suggests that tea has favourable effects on CVD risk factors, but due to the small number of trials contributing to each analysis the results should be treated with some caution and further high quality trials with longer‐term follow‐up are needed to confirm this. "]
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[null,"Hartley  L, et al. Increased consumption of fruit and vegetables for the primary prevention of cardiovascular diseases. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD009874. DOI: 10.1002/14651858.CD009874.pub2.\nAvailable here. ","Healthy adults or those at high risk of CVD. ","This Cochrane review aimed to determine the effectiveness of 1) advice to increase fruit and vegetable consumption and 2) the provision of fruit and vegetables to increase consumption, for the primary prevention of CVD.\n\nTen trials (n=1,730) and one ongoing trial were identified. Six trials investigated the provision of fruit and vegetables and four trials examined advice to increase fruit and vegetable consumption. The ongoing trial is examining the provision of an avocado‐rich diet. The number and type of intervention components for provision and the dietary advice provided differed between trials.  Change in BP was a secondary outcome of the review, the results are described below:\n\nTwo of the four studies that examined dietary advice to increase the consumption of fruit and vegetables measured blood pressure. In one study, this was at six months and in the other study at 12 months. From the pooled analysis, advice to eat fruit and vegetables significantly reduced SBP (mean difference (MD) ‐3.0 mm Hg (95% confidence interval (CI) ‐4.92 to ‐1.09; 891 participants) but the reduction in DBP was not statistically significant (MD ‐0.90 mm Hg (95% CI ‐2.03 to 0.24; 891 participants). No heterogeneity was found between trials (I2 = 0%).  ","There are very few studies to date examining provision of, or advice to increase the consumption of, fruit and vegetables in the absence of additional dietary interventions or other lifestyle interventions for the primary prevention of CVD. The limited evidence suggests advice to increase fruit and vegetables as a single intervention has favourable effects on CVD risk factors but more trials are needed to confirm this. "]
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[null,"Rees  K, et al. Dietary advice for reducing cardiovascular risk. Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.: CD002128. DOI: 10.1002/14651858.CD002128.pub5.\nAvailable here. ","Healthy adults","This Cochrane review aimed to assess the effects of providing dietary advice to achieve sustained dietary changes or improved cardiovascular risk profile among healthy adults.\n\nForty‐four trials with 52 intervention arms (comparisons) comparing dietary advice with no advice were included in the review; 18,175 participants or clusters were randomised. Twenty‐nine of the 44 included trials were conducted in the USA. Dietary advice reduced total serum cholesterol by 0.15 mmol/L (95% CI 0.06 to 0.23) and LDL cholesterol by 0.16 mmol/L (95% CI 0.08 to 0.24) after three to 24 months. Mean HDL cholesterol levels and triglyceride levels were unchanged. Dietary advice reduced blood pressure by 2.61 mm Hg systolic (95% CI 1.31 to 3.91) and 1.45 mm Hg diastolic (95% CI 0.68 to 2.22) and 24‐hour urinary sodium excretion by 40.9 mmol (95% CI 25.3 to 56.5) after three to 36 months but there was heterogeneity between trials for the latter outcome. Three trials reported plasma antioxidants, where small increases were seen in lutein and β‐cryptoxanthin, but there was heterogeneity in the trial effects. Self‐reported dietary intake may be subject to reporting bias and there was significant heterogeneity in all the following analyses. Compared to no advice, dietary advice increased fruit and vegetable intake by 1.18 servings/day (95% CI 0.65 to 1.71). Dietary fibre intake increased with advice by 6.5 g/day (95% CI 2.2 to 10.82), while total dietary fat as a percentage of total energy intake fell by 4.48% (95% CI 2.47 to 6.48) with dietary advice and saturated fat intake fell by 2.39% (95% CI 1.4 to 3.37). \n\nTwo trials analysed incident cardiovascular disease (CVD) events. Follow‐up was 77% complete at 10 to 15 years after the end of the intervention period and estimates of event rates lacked precision but suggested that sodium restriction advice probably led to a reduction in cardiovascular events (combined fatal plus non‐fatal events) plus revascularisation (study 1 hazard ratio (HR) 0.59, 95% CI 0.33 to 1.08; study 2 HR 0.81, 95% CI 0.59 to 1.12). \n","Dietary advice appears to be effective in bringing about modest beneficial changes in diet and cardiovascular risk factors over approximately 12 months, but longer‐term effects are not known"]
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[null,"Usinger  L, et al. Fermented milk for hypertension. Cochrane Database of Systematic Reviews 2012, Issue 4. Art. No.: CD008118. DOI: 10.1002/14651858.CD008118.pub2.\nAvailable here. ","Adults (age 18+).","This Cochrane review investigated whether fermented milk or similar products produced by lactobacilli fermentation of milk proteins have any blood pressure lowering effect in humans when compared to no treatment or placebo. \n\nFifteen studies were included in the review. The studies were all placebo-controlled and four studies used a cross over design. The length of studies varied from four to 23 weeks with intervention periods of  four to 21 weeks. Most studies were double-blind, but three were single-blind. One study consisted of two different arms where one received a fermented milk with added potassium and the other arm a similar fermented milk without added potassium. Another study had separate intervention groups according to the participants' baseline BP. A further study had three different intervention groups: lactotripeptides (LTP) produced synthetic, enzymatic hydrolysis and bacterial fermentation. Finally, two studies had several intervention groups with different concentration levels of the active product. \n\nAll studies, except one, had industry funding and/or some or all of the authors were employed by private food companies. Similarly in all these studies the test and placebo products were produced by the involved companies. \n\nAn overall effect was found on office SBP (MD ‐2.45; 95% CI ‐4.30, ‐0.60; n=1,232; 15 studies), but no effect on DBP (MD ‐0.67; 95% CI ‐1.48, 0.14; n=1,232; 15 studies). The length of the intervention (more than 8 weeks compared to 4‐8 weeks) did not influence the effect on BP.  After removing the eight studies with high risk of bias significant effects were seen as a result of the intervention on neither SBP (MD ‐0.57 mm Hg; 95% CI ‐3.12 to 1.98) nor DBP (MD ‐0.39 mm Hg; 95% CI ‐1.78 to 1.01). \n","The authors conclude that the review does not support an effect of fermented milk on blood pressure. Despite the positive effect on SBP the authors conclude, for several reasons, that fermented milk has no effect on blood pressure. The effect found was very modest and only on SBP, the included studies were very heterogeneous and several with weak methodology. Finally, sensitivity and subgroup analyses could not reproduce the antihypertensive effect. The results do not support the use of fermented milk as treatment for hypertension or as a lifestyle intervention for pre‐hypertension nor would it influence population blood pressure. "]
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[null,"Stabler  SN, et al. Garlic for the prevention of cardiovascular morbidity and mortality in hypertensive patients. Cochrane Database of Systematic Reviews 2012, Issue 8. Art. No.: CD007653. DOI: 10.1002/14651858.CD007653.pub2.\nAvailable here.","Adults with a diagnosis of primary hypertension (defined as having a SBP > 140 mm Hg or a DBP of > 90mm Hg, or both).","This Cochrane review aimed to determine whether the use of garlic as monotherapy, in hypertensive patients, lowers the risk of cardiovascular morbidity and mortality compared to placebo. \n\nThe search identified two RCTs for inclusion. One trial included 47 hypertensive patients and showed that garlic significantly reduces mean supine SBP by 12 mm Hg (95% CI 0.56 to 23.44 mm Hg, p=0.04) and mean supine DBP by 9 mm Hg (95% CI 2.49 to 15.51 mm Hg, p=0.007) versus placebo. The study authors state that garlic was \"free from side effects\" and that no serious side effects were reported. There were three cases \"where a slight smell of garlic was noted.\" \n\nThe second trial could not be meta‐analysed as they did not report the number of people randomised to each treatment group. They did report that 200 mg of garlic powder given three times daily, in addition to hydrochlorothiazide‐triamterene baseline therapy, produced a mean reduction of SBP by 10‐11 mm Hg and of DBP by 6‐8 mm Hg versus placebo. \n\nNeither trial reported clinical outcomes and insufficient data was provided on adverse events. \n\n\n","The authors conclude that there is insufficient evidence to determine if garlic provides a therapeutic advantage versus placebo in terms of reducing the risk of mortality and cardiovascular morbidity in patients diagnosed with hypertension. There is also insufficient evidence to determine the difference in withdrawals due to adverse events between patients treated with garlic or placebo. \n\nBased on two trials in 87 hypertensive patients, it appears that garlic reduces mean supine systolic and DBP by approximately 10‐12 mm Hg and 6‐9 mm Hg, respectively, over and above the effect of placebo but the confidence intervals for these effect estimates are not precise and this difference in blood pressure reduction falls within the known variability in blood pressure measurements. This makes it difficult to determine the true impact of garlic on lowering blood pressure. \n"]
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[null,"Peirson L et al. Prevention of overweight/obesity in adult populations: a systematic review with meta-analyses. Ottawa, Ontario: Canadian Task Force on Preventive Health Care; 2014.\nAvailable here. ","Adults of normal weight (BMI >18 and <25) In the absence of this statement the authors accepted studies when the baseline mean BMI minus one standard deviation (SD) fell below 25 kg/m2; they assumed that this result meant there were some normal weight people in the sample.","The review aimed to synthesise evidence on behavioural interventions for preventing weight gain in normal weight adults. Blood pressure change was a secondary outcome of the review and the results are reported below: \n\nSeventeen RCTs (n=48,493) of very low GRADE quality (downgraded for risk of bias, inconsistency, indirectness and imprecision) were included in the meta-analysis assessing change in SBP. Across these studies, baseline BMI ranged from 22.4 to 31.1; in four of the studies the baseline mean BMI of at least one study arm was <25; in 13 studies the baseline means were in the range for overweight/obese. In terms of type of intervention three were diet, three were exercise, three were diet plus exercise, and eight were lifestyle. Control participants received usual care from their physicians or no intervention; in five of these studies control participants received a minimal component (e.g. printed materials on healthy lifestyles). Intervention duration was 12 months or less in 12 studies and more than 12 months in five studies. There was no difference between intervention and control group participants in terms of change in SBP [MD (95% CI) -0.31 mm Hg (-0.84, 0.22); I2=77%]. \n\nFifteen RCTs (n=47,945) of very low GRADE quality (downgraded for risk of bias, inconsistency, indirectness and imprecision) were included in the meta-analysis assessing change in DBP. Across these studies, baseline BMI ranged from 22.4 to 31.1; in four of the studies the baseline mean BMI of at least one study arm was <25; in 11 studies the baseline means were in the range for overweight/obese. In terms of type of intervention three were diet, two were exercise, three were diet plus exercise and seven were lifestyle. Control participants received usual care from their physicians or no intervention; in five of these studies control participants received a minimal component (e.g. printed materials on healthy lifestyles). Intervention duration was 12 months or less in 10 studies and more than 12 months in five studies. There was no difference between intervention and control group participants in terms of change in DBP [MD (95% CI) -0.18 mm Hg (-0.44, 0.07); I2=66%]. \n\n","There is low quality evidence that behavioural interventions are associated with reductions in weight and improvements in other health outcomes in mixed weight adult populations, but it is uncertain whether the benefits are clinically meaningful and can be maintained over time. In the short term, strategies aimed at weight maintenance appear to have some benefit; if maintained, these could be clinically significant benefits.\n\nThe review authors state that results presented for secondary health outcomes (including blood pressure) should be interpreted with caution as they only included interventions that had a focus on weight gain prevention. "]
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[null,"Ymarfer corff"]
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[null,"Adolygiadau systemataidd"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Hartley  L, et al. Qigong for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2015, Issue 6. Art. No.: CD010390. DOI: 10.1002/14651858.CD010390.pub2.\nAvailable here. ","Healthy adults or adults at high risk of CVD. ","This Cochrane review aimed to determine the effectiveness of qigong for the primary prevention of CVD. Qigong involves physical exercise, mind regulation and breating control to restore the flow of Qi (a pivotal life energy). It is hypothesised that qigong can help to relieve stress and therefore may be effective in the primary prevention of CVD. \n\nThe review authors identified 11 completed trials (1369 participants) and one ongoing trial. Trials were heterogeneous in participants recruited, qigong duration and length of follow‐up periods. The review authors were unable to ascertain the risk of bias in nine trials published in Chinese, as insufficient methodological details were reported and they were unable to contact the study authors to clarify this. \n\nThe review authors did not perform a meta‐analyses, as trials were small and were at significant risk of bias. Clinical events were detailed in subsequent reports of two trials when statistically significant effects of qigong were seen for all‐cause mortality, stroke mortality and stroke incidence at 20 to 30 years after completion of the trials. However, these trials were designed to examine outcomes in the short term and it is not clear whether qigong was practised during extended periods of follow‐up; therefore effects cannot be attributed to the intervention. None of the included studies reported other non‐fatal CVD events. \n\nSix trials provided data that could be used to examine the effects of qigong on blood pressure. Reductions in SBP and DBP were seen in three and two trials, respectively. Three trials examined the effects of qigong on blood lipids when favourable effects were seen in one trial for total cholesterol, low‐density lipoprotein cholesterol and triglycerides and two trials showed favourable effects on high‐density lipoprotein cholesterol. The only trial considered at low risk of selection and detection bias did not demonstrate statistically significant effects on CVD risk factors with qigong, but this study was small and was underpowered. None of the included studies reported incidence of type 2 diabetes, adverse events, quality of life or costs. \n","Currently, very limited evidence is available on the effectiveness of qigong for the primary prevention of CVD. Most of the trials included in this review are likely to be at high risk of bias, so we have very low confidence in the validity of the results. Publication of the ongoing trial will add to the limited evidence base, but further trials of high methodological quality with sufficient sample size and follow‐up are needed to be incorporated in an update of this review before the effectiveness of qigong for CVD prevention can be established."]
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[null,"Seron  P, et al. Exercise for people with high cardiovascular risk. Cochrane Database of Systematic Reviews 2014, Issue 8. Art. No.: CD009387. DOI: 10.1002/14651858.CD009387.pub2\nAvailable here. ","Adults with an average 10-year Framinghan risk score of 10% for cardiovascular disease over 10 years, or with two or more cardiovascular risk factors and no history of cardiovascular disease. ","This Cochrane review aimed to assess the effects of exercise training in people with increased cardiovascular risk but without a concurrent cardiovascular disease on general cardiovascular mortality, incidence of cardiovascular events and total cardiovascular risk. \n\nA total of four studies were included that involved 823 participants, 412 in the exercise group and 411 in the control group. Follow‐up of participants ranged from 16 weeks to six months. Overall, the included studies had a high risk of selection, detection and attrition bias. Meta‐analysis was not possible because the interventions (setting, type and intensity of exercise) and outcome measurements were not comparable and the risk of bias in the identified studies was high. No study assessed cardiovascular or all‑cause mortality or cardiovascular events as individual outcomes. Blood pressure was a secondary outcome in the review and the results are described below:\n\nThree studies assessed the systolic and DBP levels; two of them found significant differences between the study arms that were not clinically important. \n\nFor SBP, one study reported a difference from baseline of ‐5 mm Hg (95% CI ‐9 to ‐0.3) by the end of six months in the exercise group, which was higher than the ‐1 mm Hg (95% CI ‐3 to 1) difference in the control group (p < 0.05). The other study found a difference of ‐8.30 mm Hg (95% CI ‐9.97 to ‐6.63) in the exercise group, which was higher than the ‐6.17 mm Hg (95% CI ‐7.60 to ‐4.74) difference in the control group. The difference between groups at the end of the follow‐up period, adjusted by the baseline measurement, was ‐2.46 mm Hg (95% CI ‐4.50 to ‐0.42) (p = 0.018).\n\nFor DBP, the first study reported a difference between the baseline measurement and that performed by the end of the intervention of ‐4 mm Hg (95% CI ‐7 to ‐2) in the exercise group, which was greater than the ‐1 mm Hg (95% CI ‐3 to 1) difference in the control group (p < 0.05). The second study showed a ‐4.77 mm Hg (95% CI ‐5.72 to ‐3.83) and a ‐3.60 mm Hg (95% CI ‐4.44 to ‐2.76) difference in the exercise and the control groups, respectively. The difference between groups at the end of six months of follow‐up, adjusted by the baseline measurement, was ‐1.4 (95% CI ‐2.6 to ‐0.2) (p = 0.019). \n\nThe third study assessing blood pressure found no differences between the study groups for systolic and DBP. \n","Evidence to date is entirely limited to small studies with regard to sample size, short‐term follow‐up, and high risk of methodological bias, which makes it difficult to derive any conclusions on the efficacy or safety of aerobic or resistance exercise on groups with increased cardiovascular risk or in individuals with two or more coexisting risk factors. Further randomised clinical trials assessing controlled exercise programmes on total cardiovascular risk in individuals are warranted."]
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[null,"Hartley  L, et al. Yoga for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2014, Issue 5. Art. No.: CD010072. DOI: 10.1002/14651858.CD010072.pub2.\nAvailable here. ","Healthy adults or those at high risk of CVD. ","This Cochrane review aimed to determine the effect of any type of yoga on the primary prevention fo CVD. \n\nEleven trials were identified (800 participants) and two ongoing studies. Style and duration of yoga differed between trials. Half of the participants recruited to the studies were at high risk of CVD. Most of studies were at risk of performance bias, with inadequate details reported in many of them to judge the risk of selection bias.  \n\nNo study reported cardiovascular mortality, all‐cause mortality or non‐fatal events, and most studies were small and short‐term. Blood pressure was a secondary outcome in the review and the results are reported below: \n\nNine of the 11 included studies measured blood pressure. Useable data for meta‐analysis were not available for one study, as no data for the control group were provided, only changes since baseline for the yoga group. In this study, SBP was significantly reduced by yoga (mean difference (MD) ‐5.71 mm Hg, p < 0.01) and DBP was also reduced but this did not reach statistical significance (mean difference ‐3.71 mm Hg, p reported to be non‐significant). The other eight studies could not be combined as there was substantial heterogeneity between trials (I2 = 81%) (485 participants). Two studies showed a significant reduction in SBP with the intervention, and six studies showed yoga to reduce SBP but this did not reach statistical significance. The remaining study showed a significant increase in SBP (MD 2.20, 95% confidence interval (CI) 0.16 to 4.24).\n\nFor DBP (444 participants), we found moderate heterogeneity between studies (I2 = 58%) so we performed a random‐effects meta‐analysis. From the pooled analysis, yoga was found to significantly lower DBP (MD ‐2.90, 95% CI ‐4.52 to ‐1.28). Results were similar for the fixed‐effect model but review authors reported the random‐effects results as the effect estimate is more conservative with wider confidence intervals. Sensitivity analysis, removing studies with high risk of bias based on incomplete outcome data (those with loss to follow‐up of more than 20% without intention‐to‐treat analysis), retained seven studies and statistical significance (MD ‐3.38 mm Hg, 95% CI ‐4.88 to ‐1.88).\n ","The limited evidence comes from small, short‐term, low‐quality studies. There is some evidence that yoga has favourable effects on DBP, HDL cholesterol and triglycerides, and uncertain effects on LDL cholesterol. These results should be considered as exploratory and interpreted with caution."]
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[null,null," ",null,"\n "]
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[null,"Hartley  L et al. Tai chi for primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2014, Issue 4. Art. No.: CD010366. DOI: 10.1002/14651858.CD010366.pub2.\nAvailable here.","Healthy adults or adults at high risk of CVD. ","This Cochrane review attempted to determine the effectiveness of tai chi for the primary prevention of CVD. \n\nThirteen small trials were identified (1,520 participants randomised) and three ongoing trials. All studies had at least one domain with unclear risk of bias, and some studies were at high risk of bias for allocation concealment (one study) and selective reporting (two studies). Duration and style of tai chi differed between trials. Seven studies recruited 903 healthy participants, the other studies recruited people with borderline hypertension or hypertension, elderly people at high risk of falling, and people with hypertension with liver and kidney yin deficiency syndrome.\n\nNo studies reported on cardiovascular mortality, all‐cause mortality or non‐fatal events as most studies were short term (all studies had follow‐up of one year or less). There was also considerable heterogeneity between studies, which meant that it was not possible to combine studies statistically for cardiovascular risk (I2 statistic for SBP was 96%, for DBP 96%, for total cholesterol 96%, low‐density lipoprotein‐cholesterol 95%, high‐density lipoprotein‐cholesterol 98%, triglycerides 75%). Nine trials measured blood pressure, six individual trials found reductions in SBP (reductions ranged from ‐22.0 mm Hg (95% confidence interval (CI) ‐26.3 to ‐17.7) to ‐11.5 mm Hg (95% CI ‐21.5 to ‐1.46)), two trials found no clear evidence of a difference (however, CIs were wide and an increase or decrease in SBP cannot be ruled out) and one trial found an increase in SBP with tai chi (increase 5.2 mm Hg, 95% CI 3.73 to 6.67). A similar pattern was seen for DBP: three trials found a reduction in DBP (reductions ranged from ‐12.2 mm Hg (95% CI ‐15.8 to ‐8.7) to ‐4.43 mm Hg (95% CI ‐7.14 to ‐1.72)) and three trials found no clear evidence of a difference, however again with wide CIs. ","There are currently no long‐term trials examining tai chi for the primary prevention of CVD. Due to the limited evidence available currently no conclusions can be drawn as to the effectiveness of tai chi on CVD risk factors. There was some suggestion of beneficial effects of tai chi on CVD risk factors but this was not consistent across all studies. There was considerable heterogeneity between the studies included in this review and studies were small and at some risk of bias. Results of the ongoing trials will add to the evidence base but additional longer‐term, high‐quality trials are needed."]
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[null,"Canadian Agency for Drugs and Technologies in Health\nObesity Management Interventions Delivered in Primary Care for Patients with Hypertension or Cardiovascular Disease: A Review of Clinical Effectiveness 2014 Jul 9. \nAvailable here\n","Adults with body-mass-index (BMI) of 30 or higher who have hypertension or cardiovascular disease (CVD) or both.","Greater weight loss correlated positively with greater reductions in blood pressure and cardiovascular risk factors regardless of which weight loss intervention was used. Dietary only interventions achieved greater initial weight loss than physical activity only interventions with the greatest weight loss occurring around 6 months. However, only lifestyle interventions that combine dietary changes and physical activity have been shown to produce significant differences in weight loss beyond 12 months.\n \nA lifestyle intervention and comprehensive metabolic risk factor management program resulted in weight loss associated with a substantial reduction in the symptom burden and symptom severity of atrial fibrillation. \n\nMotivational Interviewing (MI) was effective in bringing about long-term improvements in walking, and cholesterol levels, and was particularly effective for patients with elevated baseline levels of CVD risk factors. \n\nIn overweight or obese individuals at increased cardiovascular risk, Mediterranean diets appear to be more effective than low-fat diets in inducing clinically relevant long-term changes in cardiovascular risk factors and inflammatory markers, with evidence from one study demonstrating a lasting benefit of Mediterranean diets for 2 years after the beginning of the diet.\n","The pharmacological weight loss intervention studies demonstrated significantly greater weight reductions in obese patient compared to lifestyle interventions alone. \n\nLifestyle interventions for weight loss that combined diet and exercise were more successful at achieving targeted weight loss goals than diet-only interventions or physical activity-only intervention. Also, MI counselling intervention was demonstrated to be an effective tool to promote lifestyle changes leading to greater weight loss than a one-time provision of written information about diet and exercise. \n\nSignificant weight loss (≥5%) was associated with health benefits including reduction in blood pressure, both systolic and diastolic, as well as reductions in cardiovascular risk factors, including hyperglycemia, and dyslipidemia, and reduced use of concomitant medications. The degree of health benefits positively correlated with the degree of weight loss regardless of the intervention used. \n\nWith regards to dietary weight loss programs, evidence from a meta-analysis indicated that Mediterranean diets appear to be more effective than low-fat diets in inducing clinically relevant long-term changes in cardiovascular risk factors and inflammatory markers."]
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[null,"Freak‐Poli  RLA, et al. Workplace pedometer interventions for increasing physical activity. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD009209. DOI: 10.1002/14651858.CD009209.pub2.\nAvailable here. ","Employed adults.","This Cochrane review aimed to assess the effectiveness of pedometer interventions in the workplace for increasing physical activity and improving subsequent health outcomes. \n\nFour studies were included providing data for 1,809 employees, 60% of whom were allocated to the intervention group. All studies assessed outcomes immediately after the intervention had finished and the intervention duration varied between three to six months. All studies had usual treatment control conditions; however one study's usual treatment was an alternative physical activity programme while the other three had minimally active controls. In general, there was high risk of bias mainly due to lack of blinding, self reported outcome measurement, incomplete outcome data due to attrition, and most of the studies had not published protocols, which increases the likelihood of selective reporting. Change in BP was a secondary outcome of the review and the results are below:\n\nPedometer programme vs 'no intervention' control:\nTwo studies reported change from baseline for systolic and DBP. Meta‐analyses showed that there were no significant differences between the pedometer programme and the control group for SBP (MD ‐3.11 mm Hg, 95% CI ‐8.39 to 2.17) or DBP (MD ‐1.14 mm Hg, 95% CI ‐3.45 to 1.16). \n\nPedometer programme vs alternative programme without pedometer:\nOne study did not find a statistically significant difference between the pedometer programme and alternative physical activity programme for blood pressure at the end of the programme (systolic MD ‐4.00 mm Hg, 95% CI ‐10.15 to 2.15; diastolic MD ‐2.20 mm Hg, 95% CI ‐6.74 to 2.34; baseline MD: systolic ‐5.5, diastolic ‐2.8). ","There was limited and low quality data providing insufficient evidence to assess the effectiveness of pedometer interventions in the workplace for increasing physical activity and improving subsequent health outcomes. "]
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[null,"Peirson L et al. Prevention of overweight/obesity in adult populations: a systematic review with meta-analyses. Ottawa, Ontario: Canadian Task Force on Preventive Health Care; 2014.\nAvailable here. ","Adults of normal weight (BMI >18 and <25) In the absence of this statement the authors accepted studies when the baseline mean BMI minus one standard deviation (SD) fell below 25 kg/m2; they assumed that this result meant there were some normal weight people in the sample.","The review aimed to synthesise evidence on behavioural interventions for preventing weight gain in normal weight adults. Blood pressure change was a secondary outcome of the review and the results are reported below: \n\nSeventeen RCTs (n=48,493) of very low GRADE quality (downgraded for risk of bias, inconsistency, indirectness and imprecision) were included in the meta-analysis assessing change in SBP. Across these studies, baseline BMI ranged from 22.4 to 31.1; in four of the studies the baseline mean BMI of at least one study arm was <25; in 13 studies the baseline means were in the range for overweight/obese. In terms of type of intervention three were diet, three were exercise, three were diet plus exercise, and eight were lifestyle. Control participants received usual care from their physicians or no intervention; in five of these studies control participants received a minimal component (e.g. printed materials on healthy lifestyles). Intervention duration was 12 months or less in 12 studies and more than 12 months in five studies. There was no difference between intervention and control group participants in terms of change in SBP [MD (95% CI) -0.31 mm Hg (-0.84, 0.22); I2=77%]. \n\nFifteen RCTs (n=47,945) of very low GRADE quality (downgraded for risk of bias, inconsistency, indirectness and imprecision) were included in the meta-analysis assessing change in DBP. Across these studies, baseline BMI ranged from 22.4 to 31.1; in four of the studies the baseline mean BMI of at least one study arm was <25; in 11 studies the baseline means were in the range for overweight/obese. In terms of type of intervention three were diet, two were exercise, three were diet plus exercise and seven were lifestyle. Control participants received usual care from their physicians or no intervention; in five of these studies control participants received a minimal component (e.g. printed materials on healthy lifestyles). Intervention duration was 12 months or less in 10 studies and more than 12 months in five studies. There was no difference between intervention and control group participants in terms of change in DBP [MD (95% CI) -0.18 mm Hg (-0.44, 0.07); I2=66%]. \n\n","There is low quality evidence that behavioural interventions are associated with reductions in weight and improvements in other health outcomes in mixed weight adult populations, but it is uncertain whether the benefits are clinically meaningful and can be maintained over time. In the short term, strategies aimed at weight maintenance appear to have some benefit; if maintained, these could be clinically significant benefits.\n\nThe review authors state that results presented for secondary health outcomes (including blood pressure) should be interpreted with caution as they only included interventions that had a focus on weight gain prevention. "]
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[null,"Meddyginiaeth amgen"]
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[null,"Adolygiadau systemataidd"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Yang  J, et al. Acupuncture for hypertension. Cochrane Database of Systematic Reviews 2018, Issue 11. Art. No.: CD008821. DOI: 10.1002/14651858.CD008821.pub2.\nAvailable here. ","Adults with primary hypertension.","Twenty‐two randomised controlled trials (RCTs) (1,744 people) met the inclusion criteria for the review. The RCTs were of variable methodological quality (most at high risk of bias because of lack of blinding). There was no evidence for a sustained BP lowering effect of acupuncture; only one trial investigated a sustained effect and found no BP lowering effect at three and six months after acupuncture. Four sham acupuncture controlled trials provided very low quality evidence that acupuncture had a short‐term (one to 24 hours) effect on SBP (change) ‐3.4 mm Hg (‐6.0 to ‐0.9) and DBP ‐1.9 mm Hg (95% CI ‐3.6 to ‐0.3). Pooled analysis of eight trials comparing acupuncture with angiotensin‐converting enzyme inhibitors and seven trials comparing acupuncture to calcium antagonists suggested that acupuncture lowered short‐term blood pressure (BP) better than the antihypertensive drugs. However, because of the very high risk of bias in these trials, the review authors concluded that this was most likely a reflection of bias and not a true effect. As a result, the authors did not report these results in the 'Summary of findings' table. Safety of acupuncture could not be assessed as only eight trials reported adverse events. ","At present, there is no evidence for the sustained BP lowering effect of acupuncture that is required for the management of chronically elevated BP. The short‐term effects of acupuncture are uncertain due to the very low quality of evidence. The larger effect shown in non‐sham acupuncture controlled trials most likely reflects bias and is not a true effect. Future RCTs must use sham acupuncture controls and assess whether there is a BP lowering effect of acupuncture that lasts at least seven days."]
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[null,"Zhang  HW, et al. Tianma Gouteng Yin Formula for treating primary hypertension. Cochrane Database of Systematic Reviews 2012, Issue 6. Art. No.: CD008166. DOI: 10.1002/14651858.CD008166.pub2.\nAvailable here.","Patients with primary hypertension, including men and non-pregnant women. ","This Cochrane review aimed to assess the efficacy and safety of Tianma Gouteng Yin Formula (TGYF) for treating primary hypertension compared to placebo or no treatment. TGYF, a mixture of herbs,  is widely used to treat hypertension-related symptoms in clinical practice in East Asia\n\nNo studies were identified which met the inclusion criteria for the review. ","As no trials could be identified, no conclusions can be made about the role of TGYF in the treatment of primary hypertension. Well‐designed RCTs need to be conducted and published. "]
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[null,"Atchwanegiadau"]
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[null,"Adolygiadau systemataidd"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Al‐Khudairy L, et al.  Vitamin C supplementation for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No.: CD011114. DOI: 10.1002/14651858.CD011114.pub2\nAvailable here. ","Healthy adults (18 years old or over) from the general population and those at moderate to high risk of CVD (e.g. hypertension, hyperlipidaemia, overweight/obesity).","The aim of this Cochrane review was to determine the effectiveness of vitamin C supplementation as a single supplement for the primary prevention of CVD. \n\nEight trials were included with 15,445 participants randomised. The largest trial with 14,641 participants provided data on the primary outcomes. Seven trials reported on CVD risk factors. Three of the eight trials were regarded at high risk of bias for either reporting or attrition bias, most of the 'Risk of bias' domains for the remaining trials were judged as unclear, with the exception of the largest trial where most domains were judged to be at low risk of bias. Blood pressure was a secondary outcome of the review and the results are reported below:\n\nOne trial reported data that could be used in a meta‐analysis. This trial reported no effects of vitamin C supplementation on either SBP (mean difference (MD) ‐1.00 mm Hg, 95% CI ‐4.94 to 2.94; 16 participants) or DBP (MD ‐2.00 mm Hg, 95% CI ‐6.82 to 2.82; 16 participants). However, this study was extremely small, at high risk of attrition bias so results should be treated with caution. Antihypertensive medication was also used by some participants, which may have impacted on the results obtained. \n\nNo control group data were provided for one trial so these were not usable in a meta‐analysis. \n\nOne cross‐over trial reported results over the whole trial period and not in phases so the results could not be incorporated in the meta‐analysis. The review authors reported that clinic blood pressure did not change between the placebo and vitamin C stages. Daytime ambulatory blood pressure showed a smaller decrease in SBP of 2 ± 5.2 mm Hg in comparison to DBP 1 ± 4.7 mm Hg for 40 participants. \n\nFor one study, blood pressure was reported at baseline but not at follow‐up (ASAP Study). \n\n\n","Currently, there is no evidence to suggest that vitamin C supplementation reduces the risk of CVD in healthy participants and those at increased risk of CVD, but current evidence is limited to one trial of middle‐aged and older male physicians from the USA. There is limited low‐ and very low‐quality evidence currently on the effect of vitamin C supplementation and risk of CVD risk factors. "]
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[null,"Ho J, Li E, Wright J. Blood pressure lowering efficacy of coenzyme Q10 for primary hypertension. Cochrane Database of Systematic Reviews 2016, Issue 3. Art. No.: CD007435. DOI: 10.1002/14651858.CD007435.pub3.\nAvailable here. ","Patients with primary hypertension.","This cochrane review update aimed to determine the blood pressure lowering effect of coenzyme Q10 in primary hypertension. \n\nIn this update of the review, one new randomised, controlled cross‐over trial with a total of 30 participants was added, and one trial included in the initial review was excluded. Only two of the three included trials were pooled in the meta‐analysis, as one trial was judged to have an unacceptably high risk of bias. In the meta‐analysis of two RCTs (50 participants), coenzyme Q10 did not significantly change systolic BP: ‐3.68 mm Hg (95% confidence interval (CI) ‐8.86 to 1.49), or diastolic BP: ‐2.03 mm Hg (95% CI ‐4.86 to 0.81] ), based on clinic data. ","This review provides moderate‐quality evidence that coenzyme Q10 does not have a clinically significant effect on blood pressure. In one of three trials reporting adverse effects, coenzyme Q10 was well tolerated. Due to the small number of individuals and studies available for analysis, more well‐conducted trials are needed. "]
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[null,"Technoleg"]
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[null,"Adolygiadau systemataidd"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Community Preventive Services Taskforce Task Force Finding and Rationale Statement. Cardiovascular disease prevention: Interactive digital interventions for blood pressure self-management. The Community Guide; 2017.\nAvailable here. ","Participants with high blood pressure. ","This report examines interactive digital interventions for blood pressure self-management, leading to a Community Preventative Task Force (CPSTF) recommendation on the subject. The CPSTF finding is based on the results of a published systematic review (McLean G, Band R, Saunderson K, Hanlon P, Murray E, et al. Digital interventions to promote self-management in adults with hypertension: systematic review and meta-analysis. Journal of Hypertension 2016;34(4):600-12) which included seven RCTs of trials examining the impact of digital interventions on systolic and DBP among recruited participants with high blood pressure. The CPSTFs conclusion of sufficient evidence was based on the magnitude of effect estimates, number of studies, and consistency of effects. \n \nA statistically significant effect for digital interventions was found when pooling results for both SBP (MD -3.7 mm Hg [95% CI -5.3 to -2.2]; six studies) and DBP (MD -2.4 mm Hg [95% CI -4.4 to -0.04]; five studies. One included study also examined the proportion of patients achieving or maintaining blood pressure control. At 24 month follow-up, intervention group participants were significantly more likely to have their blood pressure under control (odds ratio 1.52; [95% CI 1.01 to 2.30]).\n","The Community Preventive Services Task Force (CPSTF) recommends interactive digital interventions for patients who have high blood pressure based on sufficient evidence of effectiveness in reducing blood pressure. Evidence was considered sufficient based on studies that demonstrated improvements in patients’ blood pressure measurements over intervention periods of six weeks to 24 months (median six months)."]
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[null,"Posadzki  P, et al. Automated telephone communication systems for preventive healthcare and management of long‐term conditions. Cochrane Database of Systematic Reviews 2016, Issue 12. Art. No.: CD009921. DOI: 10.1002/14651858.CD009921.pub2.\nAvailable here. ","Consumers (including carers) who received automated telephone communication systems (ATCS) interventions for prevention or management of long-term conditions, regardless of age, sex, education, marital status, employment status or income. ATCS deliver voice messages and collect information from consumers. ","This Cochrane review aimed to assess the effects of ATCS on behavioural change, clinical, process, cognitive, patient-centred and adverse outcomes, for preventing disease and managing long-term conditions. \n\nThere are four different types of ATCS: unidirectional (one-way, non-interactive voice communication), interactive voice response (IVR) systems, ATCS with additional functions such as access to an expert to request advice (ATCS Plus) and multimodal ATCS, where the calls are delivered as part of a multicomponent intervention.\n\nOne hundred and thirty two trials (n = 4,699,689) were included in the whole review and studies spanned several clinical areas, assessing many comparisons based on evaluation of different ATCS types and variable comparison groups. The results for ATCS versus usual care for management of hypertension are reported below:\n\nFive studies evaluated ATCS for managing hypertension; one took place in Honduras/Mexico, and four were in the USA. Sample size ranged from 166 to 64,773 participants. Mean age ranged from 58 years to 66 years. Participants in three studies were also diagnosed with diabetes mellitus. All studies monitored blood pressure as a primary outcome. \n\nMeta‐analysis of three trials, found that ATCS slightly reduced SBP compared with usual care with or without information (MD −1.89 mm Hg, 95% −2.12 to −1.66; moderate certainty evidence). There was no evidence of heterogeneity among the pooled studies (Tau2 = 0.00; Chi2 = 1.48, df = 2 (P = 0.48); I2 = 0%). \n\nMeta‐analysis of two trials reported no effect for ATCS on DBP compared with usual care (MD 0.02 mm Hg, 95% CI −2.62 to 2.66; low certainty evidence). There was a substantial degree of heterogeneity in the meta‐analysed studies (Tau2 = 2.84; Chi2 = 3.63, df = 1 (p = 0.06); I2 = 72%). \n\nTwo studies were not included in the meta-analysis as they reported different outcomes or insufficient information to allow inclusion. One study found that compared with usual care, a multimodal/complex intervention (ATCS Plus plus sphygmomanometer, a weighting scale, pedometer, and instructions on their use) probably had little or no effect on blood pressure control at six months (54.5% controlled in intervention group versus 52.3% in usual care group, p = 0.43; moderate certainty evidence). \n\nOne study reported that compared with usual care plus education, IVR may have had little or no effect on SBP at three months (p > 0.05; low certainty evidence). \n\n\n","ATCS interventions can change patients' health behaviours, improve clinical outcomes and increase healthcare uptake with positive effects in several important areas including immunisation, screening, appointment attendance, and adherence to medications or tests. The decision to integrate ATCS interventions in routine healthcare delivery should reflect variations in the certainty of the evidence available and the size of effects across different conditions, together with the varied nature of ATCS interventions assessed. Future research should investigate both the content of ATCS interventions and the mode of delivery; users' experiences, particularly with regard to acceptability; and clarify which ATCS types are most effective and cost‐effective. "]
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[null,"Canadian Agency for Drugs and Technologies in Health. Telehealth for patients with Hypertension, Coronary Artery Disease or Implantable Cardiac Devices: A Review of the Clinical Effectiveness, Cost-effectiveness and Guidelines. Rapid response report: summary with critical appraisal. CADTH; 2016. \nAvailable here. ","Patients with hypertension, CAD and implantable cardiac devices requiring cardiac care. ","This rapid response report aims to review the clinical- and cost-effectiveness of telehealth for patients with hypertension, coronary artery disease (CAD) or conditions requiring implantable cardiac devices.\n\nA total of twelve studies on telehealth for hypertension (four studies), CAD (two studies) and implantable cardiac devices (six studies) were included in the review. Five studies were systematic reviews on clinical effectiveness of telemonitoring, six were cost-effectiveness studies and one was a guideline. \n\nClinical evidence of telehealth for patients with hypertension: \n\nOne systematic review which evaluated the clinical effectiveness of home blood pressure telemonitoring (HBPT) was identified. The systematic review/meta-analysis included 23 RCTs that evaluated the clinical effectiveness of home blood pressure telemonitoring (HBPT), compared to usual care, in adult patients with hypertension, with mean SBP of 144.9 ± 11.4 (SD), and mean DBP of 84.5 ± 5.7 (SD). HBPT was found to improve SBP and DBP, with a difference of 4.71 mm Hg and 2.45 mm Hg, respectively, compared to usual care. The differences were statistically significant. HBPT also increased the chances for patients to achieve office BP normalisation in both diabetic and non-diabetic populations by 16% (relative risk [RR] 1.16; p < 0.001). HBPT helped improve the physical component of quality of life (SF-12 or SF-36 questionnaire: weighted mean difference [WMD] +2.78; 95% confidence interval [CI] +1.15 to +4.41; p < 0.001). There was no statistically significant difference in both intervention and usual care groups in terms of therapeutic adherence, rate of office consultations, and risk of adverse events.\n\n\n","Telemonitoring of blood pressure costs more than usual care, but it may represent a useful tool for hypertension control by improving blood pressure and increasing the chances for patients to achieve blood pressure normalisation. There was no evidence available on the cost-effectiveness of telemonitoring in patients with CAD requiring cardiac rehabilitation, but telehealth interventions do not have inferior outcomes compared to centre-based supervised programs, and telephone support may reduce hospitalisations and reduce risk factors for heart disease. For patients with heart diseases requiring implantable cardiac devices, the costs of telemonitoring were lower than conventional hospital monitoring. Pacemaker telemonitoring led to earlier cardiovascular event detection, with a reduction in hospital visits and hospitalisations. Telemonitoring of implantable cardioverter-defibrillators had similar outcomes compared to in-office follow-up."]
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[null,"Flodgren  G, et al. Interactive telemedicine: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD002098. DOI: 10.1002/14651858.CD002098.pub2.\nAvailable here. ","Participants with any chronic condition (including those with hypertension).","This Cochrane review aimed to assess the effectiveness, acceptability and costs of interactive telemedicine as an alternative, or in addition to, usual care (i.e. face-to-face care or telephone consultation). \n\nNinety-three trials were included in the review (n=22,047 participants) which evaluated the effectiveness of interactive telemedicine delivered in addition to (32% of studies), as an alternative to (57% of studies), or partly substituted for usual care (11%) as compared to usual care alone. Four studies were in participants with hypertension.\n\nIn the studies assessing telemedicine in patients with hypertension, blood pressure measurement varied among studies at follow‐up. One study (n = 387) reported a greater decrease in mean SBP in telemedicine delivered care in addition to usual care, as compared with usual care alone at 12 months; one study (n = 236) reported no differences in diastolic daytime and night time ambulatory blood pressure (ABPM) between groups at six months but did report that a greater proportion of intervention patients achieved a target BP at six months. One study (n = 121) reported a greater decrease in 24‐hour systolic and diastolic ABPM and a greater change in mean BP in the telemedicine group at eight weeks, as compared with control. In one monitoring study with automated review of data with alerts (n = 329), the authors reported a greater proportion of telemedicine participants achieving daytime normalisation of arterial BP as compared with control.","The findings in our review indicate that the use of telemedicine in the management of heart failure appears to lead to similar health outcomes as face‐to‐face or telephone delivery of care; there is evidence that telemedicine can improve the control of blood glucose in those with diabetes. The cost to a health service and acceptability by patients and healthcare professionals, is not clear due to limited data reported for these outcomes. The effectiveness of telemedicine may depend on a number of different factors, including those related to the study population e.g. the severity of the condition and the disease trajectory of the participants, the function of the intervention e.g., if it is used for monitoring a chronic condition, or to provide access to diagnostic services, as well as the healthcare provider and healthcare system involved in delivering the intervention."]
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[null,"de Jongh  T, et al. Mobile phone messaging for facilitating self‐management of long‐term illnesses. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD007459. DOI: 10.1002/14651858.CD007459.pub2.\nAvailable here. ","All study participants regardless of age, gender, ethnicity, and type and stage of disease.","This Cochrane review aimed to assess the effects of mobile phone messaging applications designed to facilitate self-management of long-term illnesses on health outcomes and patients' capacity to self-manage their condition. \n\nFour RCTs (reported in seven papers) were included in the review. One of these studies looked at patients with hypertension, and compared systolic and DBP in groups of patients with and without text message support, at baseline and one, three and six months after initiation of the study. Blood pressure levels at six months were comparable in the two groups (SBP MD 1.10, 95% CI ‐4.37 to 6.57); DBP MD 1.84, 95% CI ‐2.14 to 5.82). Achievement of good blood pressure control (as defined by having blood pressure less than 140/90 mm Hg in patients without diabetes and 130/85 mm Hg in patients with diabetes) at the end of the study was not statistically different between the control and intervention groups (RR of not achieving blood pressure control 0.73, 95% CI 0.41 to 1.29). The body weight of the participants at six months was also comparable between groups (MD ‐ 2.76 (95% CI ‐8.17 to 2.65). For all of the reported outcome measures the evidence is considered to be of moderate quality only, due to the small number of patients enrolled in the trial. The observed effect sizes are likely to be affected by further research.\n\n","The authors conclude that there was some very limited indications that in certain cases mobile phone messaging interventions may provide benefit in supporting the self‐management of long‐term illnesses. However, there are significant information gaps regarding the long‐term effects, acceptability, costs, and risks of such interventions. Given the enthusiasm with which so‐called mHealth interventions are currently being implemented, further research into these issues is needed.  "]
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[null,"Arall "]
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[null,"Adolygiadau systemataidd"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Acin MT et al. Alcohol intake reduction for controlling hypertension. Cochrane Database of Systematic Reviews 2020, Issue 9. Art. No.: CD010022. DOI: 10.1002/14651858.CD010022.pub2. \nAvailable here.","Participants were adults (16 years of age or older) with systolic blood pressure (SBP) greater than 140 mmHg and diastolic blood pressure (DBP) greater than 90 mmHg, and SBP ≥ 130 or DBP ≥ 80 mmHg in participants with diabetes. ","The authors sought to assess the effect of any intervention to reduce alcohol intake in terms of blood pressure decrease in hypertensive people with alcohol consumption compared to a control intervention or no intervention at all. The authors included one trial with 269 participants, followed up for 24 months. They assessed data to identify differences in blood pressure, number of deaths and serious diseases between a group of people receiving psychological assistance (in the form of cognitive behavioural therapy) to reduce alcohol intake and people not receiving this assistance.\nNo differences were found between the cognitive-behavioural intervention group and the control group for overall mortality (RR 0.72, 95%CI 0.16 to 3.17; low-certainty evidence), cardiovascular mortality (not estimable) and cardiovascular events (RR 0.80, 95% CI 0.36 to 1.79; very low-certainty evidence). There was no statistical difference in systolic blood pressure (SBP) reduction (Mean Difference (MD) -0.92mmHg, 95% confidence interval (CI) -5.66 to 3.82 mmHg; very low-certainty evidence) or diastolic blood pressure (DBP) decrease (MD 0.98mmHg, 95% CI -1.69 to 3.65 mmHg; low-certainty evidence) between the cognitive behavioural intervention group and the control group. The authors did not find any differences in the proportion of subjects with SBP < 140 mmHg and DBP < 90 mmHg (Risk Ratio (RR) 1.21, 95%CI 0.88 to 1.65; very low-certainty evidence).\n","An intervention for decreasing alcohol intake consumption did not result in differences in systolic and diastolic blood pressure when compared with a control intervention, although there was a reduction in alcohol intake favouring the active intervention. No differences were found either for overall mortality, cardiovascular mortality or cardiovascular events. No data on serious adverse events or quality of life were available to assess. Adequate randomised controlled trials are needed to provide additional evidence on this specific question."]
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[null,"Steed  L et al. Community pharmacy interventions for health promotion: effects on professional practice and health outcomes. Cochrane Database of Systematic Reviews 2019, Issue 12. Art. No.: CD011207.\nAvailable here.","Pharmacy workers, including pharmacists and counter assistants; adult pharmacy users with varying health conditions including: hypertension, diabetes, cardiovascular disease and dyslipidemia. ","The aim of this Cochrane review was to assess the effectiveness and safety of health‐promotion interventions to change community pharmacy workers' professional practice and improve outcomes for users of community pharmacies.\n\nThe authors included 57 randomised trials with 16,220 participants, described in 83 reports. Most interventions were educational, or incorporated skills training. Interventions were directed at pharmacy workers (n = 8), pharmacy users (n = 13), or both (n = 36). The clinical areas most frequently studied were diabetes, hypertension, asthma, and modification of cardiovascular risk. \n\nMost studies (47 of 57) were directed towards secondary prevention of conditions, including cardiovascular disease (1 study), type 2 diabetes (10 studies), dyslipidaemia (4 studies), and hypertension (4 studies). In approximately half of these conditions the intervention was described as being focused on the pharmacy user, whilst the other half mentioned some degree of training for the community pharmacy workers. \n\nThe authors conducted subgroup analyses for different patient behaviours, clinical conditions, and generic versus specific quality of life measures. When analysing the data across studies, when there were related outcomes from the same study, the authors used the most clinically rigorous measure. For hypertension this was: systolic blood pressure followed by diastolic blood pressure. Sub‐group analyses separated by condition suggested that interventions probably improve blood pressure in hypertension (SMD ‐0.34, 95% CI ‐0.49 to ‐0.18; I2 = 18%; 4 trials; 1050 participants; moderate‐certainty evidence; Analysis 1.2). Interventions probably improve blood glucose levels in diabetes (SMD ‐0.81, 95% CI ‐1.60 to ‐0.02; I2 = 96%; 6 trials; 651 participants; moderate‐certainty evidence; Analysis 1.2), though the high level of heterogeneity is important here. Interventions probably made little or no difference for cardiovascular risk (SMD ‐0.08, 95% CI ‐0.40 to 0.24; I2 = 0%; 2 trials, 150 participants; moderate‐certainty evidence; Analysis 1.2). \n\nMost studies (35 of 57) included some level of intermediate clinical outcome. The ones measured most consistently were in asthma (9 studies), diabetes (10 studies) and cardiovascular risk (hypertension (8 studies) and dyslipidaemia (4 studies)). Health‐promotion interventions probably improve intermediate clinical outcomes slightly in pharmacy users (SMD ‐0.43, 95% CI ‐0.65 to ‐0.21; I2 = 90%; 20 trials, 3971 participants; moderate‐certainty evidence).","The findings of this review suggest that the community pharmacy is potentially a helpful setting in which to offer behavioural and health‐promotion interventions. There is evidence to suggest that such interventions probably slightly improve pharmacy user health‐related behaviour, intermediate clinical outcomes ‐ particularly for diabetes and hypertension ‐ and quality of life.\n\nSuch interventions are likely to be cost‐effective and the effects are seen across a range of clinical conditions and health‐related behaviours. Nevertheless the magnitude of the effects varies between conditions, and more effective interventions might be developed if greater consideration were given to the theoretical basis of the intervention and mechanisms for effecting behaviour change. \n\nIn summary, health‐promotion interventions in the community pharmacy context probably improve pharmacy workers' behaviour and probably have a slight beneficial effect on health‐related behaviour, intermediate clinical outcomes, and quality of life for pharmacy users."]
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[null,"Karmali  KN, et al. Risk scoring for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2017, Issue 3. Art. No.: CD006887. DOI: 10.1002/14651858.CD006887.pub4.\nAvailable here.","Adults without CVD.","This Cochrane review aimed to assess the effects of evaluating and providing CVD risk scores in adults, without prevalent CVD, on cardiovascular outcomes, risk factor levels, preventive medication prescribing, and health behaviours. \n\nWe identified 41 RCTs involving 194,035 participants. We assessed studies as having high or unclear risk of bias across multiple domains. Low‐quality evidence suggests that providing CVD risk scores may have little or no effect on CVD events compared with usual care (5.4% versus 5.3%; RR 1.01, 95% confidence interval (CI) 0.95 to 1.08; I² = 25%; 3 trials, n = 99,070). Providing CVD risk scores may reduce CVD risk factor levels by a small amount compared with usual care. Providing CVD risk scores reduced total cholesterol (MD −0.10 mmol/L, 95% CI −0.20 to 0.00; I² = 94%; 12 trials, n = 20,437, low‐quality evidence), SBP (MD −2.77 mm Hg, 95% CI −4.16 to −1.38; I² = 93%; 16 trials, n = 32,954, low‐quality evidence), and multivariable CVD risk (SMD −0.21, 95% CI −0.39 to −0.02; I² = 94%; 9 trials, n = 9549, low‐quality evidence). Providing CVD risk scores may reduce adverse events compared with usual care, but results were imprecise (1.9% versus 2.7%; RR 0.72, 95% CI 0.49 to 1.04; I² = 0%; 4 trials, n = 4630, low‐quality evidence). Compared with usual care, providing CVD risk scores may increase new or intensified lipid‐lowering medications (15.7% versus 10.7%; RR 1.47, 95% CI 1.15 to 1.87; I² = 40%; 11 trials, N = 14,175, low‐quality evidence) and increase new or increased antihypertensive medications (17.2% versus 11.4%; RR 1.51, 95% CI 1.08 to 2.11; I² = 53%; 8 trials, n = 13,255, low‐quality evidence). ","There is uncertainty whether current strategies for providing CVD risk scores affect CVD events. Providing CVD risk scores may slightly reduce CVD risk factor levels and may increase preventive medication prescribing in higher‐risk people without evidence of harm. There were multiple study limitations in the identified studies and substantial heterogeneity in the interventions, outcomes and analyses, so readers should interpret results with caution. New models for implementing and evaluating CVD risk scores in adequately powered studies are needed to define the role of applying CVD risk scores in primary CVD prevention. "]
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[null,"Smith SM, et al. Shared care across the interface between primary and specialty care in management of long term conditions. Cochrane Database of Systematic Reviews 2017, Issue 2. Art. No.: CD004910. DOI: 10.1002/14651858.CD004910.pub3.\nAvailable here.","People or populations with a specific chronic disease (e.g. hypertension), primary care physicians and specialist care physicians. ","This Cochrane review aimed to determine the effectiveness of shared care health service interventions designed to improve the management of chronic disease across the primary/specialty care interface. This is an update of a previously published review. \n\nThe authors identified 42 studies of shared care interventions for chronic disease management (n = 18,859), 39 of which were RCTs, two CBAs and one an NRCT. Of these 42 studies, 41 examined complex multi‐faceted interventions and lasted from six to 24 months. Overall, review authors confidence in results regarding the effectiveness of interventions ranged from moderate to high certainty. Results showed probably few or no differences in clinical outcomes overall with a tendency towards improved blood pressure management in the small number of studies on shared care for hypertension, chronic kidney disease and stroke (mean difference (MD) 3.47, 95% confidence interval (CI) 1.68 to 5.25)(based on moderate‐certainty evidence). \n\n","This review suggests that shared care improves depression outcomes and probably has mixed or limited effects on other outcomes. Methodological shortcomings, particularly inadequate length of follow‐up, may account in part for these limited effects.  Shared care interventions for conditions other than depression should be developed within research settings, with account taken of the complexity of such interventions and awareness of the need to carry out longer studies to test effectiveness and sustainability over time. "]
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[null,"Dyakova  M, et al.  Systematic versus opportunistic risk assessment for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2016, Issue 1. Art. No.: CD010411. DOI: 10.1002/14651858.CD010411.pub2.\nAvailable here. ","Healthy adults from the general population including those who are at risk of CVD.","This Cochrane review aimed to assess the effectiveness, costs and adverse effects of systematic risk assessment compared to opportunistic risk assessment for the primary prevention of CVD. \n\nNine completed RCTs met the inclusion criteria for the review, of which four were cluster‐randomised. The authors also identified five ongoing trials. The included studies had a high or unclear risk of bias, and the GRADE ratings of overall quality were low or very low. Blood pressure change was a secondary outcome for the review, the results are reported below: \n\nSix studies reported SBP at follow‐up and were combined in a meta‐analysis. Mean SBP was lower in the intervention group compared with the control group (MD ‐3.05 mm Hg, 95% CI ‐4.84 to ‐1.25; participants = 12,591; studies = 6; I² = 82%; very low‐quality evidence). There was considerable statistical heterogeneity, so review auhtors combined the data with a random‐effects model. Sensitivity analysis suggested that BFHS 1994 had a considerable impact on the results. Removing this study from the analysis reduced statistical heterogeneity to 0% and reduced uncertainty, as demonstrated by a narrower confidence interval. The mean difference, although slightly less, remained statistically significant (MD ‐1.91 mm Hg, 95% CI ‐2.67 to ‐1.16; participants = 10,584; studies = 5; I² = 0%). \n\nSix studies reported DBP at follow‐up and were combined in a meta‐analysis. Mean DBP was lower in the intervention group compared with the control group (MD ‐1.34 mm Hg, 95% CI ‐1.76 to ‐0.93; participants = 12,591; studies = 6; I² = 0%; low‐quality evidence). ","The results are limited by the heterogeneity between trials in terms of participants recruited, interventions and duration of follow‐up. Limited data suggest that systematic risk assessment for CVD has no statistically significant effects on clinical endpoints. There is limited evidence to suggest that CVD systematic risk assessment may have some favourable effects on cardiovascular risk factors. The completion of the five ongoing trials will add to the evidence base. "]
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[null,"Weeks  G, et al. Non‐medical prescribing versus medical prescribing for acute and chronic disease management in primary and secondary care. Cochrane Database of Systematic Reviews 2016, Issue 11. Art. No.: CD011227. DOI: 10.1002/14651858.CD011227.pub2.\nAvailable here. ","Healthcare providers who are not medical doctors, undertaking prescribing including, nurses, optometrists, pharmacists, physician assistants, and other allied health professionals or categories not specifically mentioned whose roles meet the authors definition of non‐medical prescribing","This Cochrane review aimed to assess clinical, patient-reported and resource use outcomes of non-medical prescribing for managing acute and chronic health conditions in primary and secondary care settings compared with medical prescribing (usual care). \n\nForty-six studies were included in the review (37,337 participants); non‐medical prescribing was undertaken by nurses in 26 studies and pharmacists in 20 studies. In 45 studies non‐medical prescribing as a component of care was compared with usual care medical prescribing. A further study compared nurse prescribing supported by guidelines with usual nurse prescribing care. No studies were found with non‐medical prescribing being undertaken by other health professionals. The education requirement for non‐medical prescribing varied with country and location. \n\nNon-medical prescribing in chronic care (primary/ambulatory care):\n\nEleven ambulatory care studies (2076 participants) reporting SBP at six months showed a mean difference (MD) favouring the non‐medical prescribing group compared to usual care of ‐6.76 mm Hg (95% CI ‐8.24 to ‐5.27;), but there was considerable heterogeneity (I2 = 82%, overall effect p < 0.00001). At 12 months, 12 ambulatory care studies (4229 participants) showed a MD favouring the non‐medical prescribing group of ‐5.31 mm Hg (95% CI ‐6.46 to ‐4.16) with moderate heterogeneity (I2 = 50%, overall effect p < 0.00001). The test for subgroup differences was not significant (I2 = 56.3%, p= 0.13). \n\nThe SBP effect estimate at six months for the fixed‐effect model was MD ‐6.76 mm Hg, 95% CI ‐8.24 to ‐5.27 compared to the random‐effects estimate (MD ‐7.34 mm Hg, 95% CI ‐11.09 to ‐3.60). At 12 months the respective comparison was MD ‐5.31 mm Hg, 95% CI ‐6.46 to ‐4.16 versus MD ‐5.91 mm Hg, 95% CI ‐7.71 to ‐4.10. There was a moderate‐certainty of evidence.\n\nExcluding the cluster‐RCT at six months, the effect estimate was MD ‐6.13 mm Hg, 95% CI ‐7.83 to ‐4.44; 10 studies, 1628 participants. Excluding the cluster‐RCTs at 12 months, the effect estimate was MD ‐4.84 mm Hg, 95% CI ‐6.29 to ‐3.39; 10 studies, 2627 participants. \n\nThe subgroup analysis of four studies (695 participants) where non‐medical prescribers demonstrated a higher level of prescribing autonomy in the control of SBP showed: fixed‐effect MD ‐2.98 mm Hg, 95% CI ‐5.36 to ‐0.59; p = 0.01, compared with a random‐effects model MD ‐6.78 mm Hg, 95% CI ‐15.38 to 1.81; p = 0.12, with considerable heterogeneity I2 = 90%. \n\n\n\n","The findings suggest that non‐medical prescribers, practising with varying but high levels of prescribing autonomy, in a range of settings, were as effective as usual care medical prescribers. Non‐medical prescribers can deliver comparable outcomes for SBP, glycated haemoglobin, low‐density lipoprotein, medication adherence, patient satisfaction and health‐related quality of life. It was difficult to determine the impact of non‐medical prescribing compared to medical prescribing for adverse events and resource use outcomes due to the inconsistency and variability in reporting across studies. Future efforts should be directed towards more rigorous studies that can clearly identify the clinical, patient‐reported, resource use, and economic outcomes of non‐medical prescribing, in both high‐income and low‐income countries. "]
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[null,"Weiss J et al. Benefits and Harms of Treating Blood Pressure in Older Adults: A Systematic Review and Meta-analysis. Portland: Department of Veterans Affairs, evidence based synthesis program; 2016.\nAvailable here.","Adults ≥ 60 years with a diagnosis of hypertension at the time of enrolment","This review from the Department of Veterans Affairs evidence based synthesis programme aimed to examine the benefits and harms of differing blood pressure targets among adults aged over 60. \n\nTwenty-one RCTs and three cohort studies were included in the review. Overall, the review found high strength of evidence that treating blood pressure in patients over age 60 to current treatment targets (<150/90 mm Hg) substantially reduces mortality, stroke and cardiac events. Most of the data came from trials in which the mean baseline SBP was 160 mm Hg. The review authors found evidence driven mainly by one large trial, that lower targets (SBP < 140 mm Hg or DBP < 85 mm Hg) compared to higher targets reduced stroke (moderate strength evidence) and cardiac events (low strength evidence); mortality was also reduced though not significantly (low strength evidence). There is little data that directly helps distinguish benefits between SBP 140 and 150 mm Hg. Most of the trials achieving SBP < 140 mm Hg were the treat-to-target trials. Only one trial included patients with baseline SBP 140-150 mm Hg and found an improvement in mortality, but not other outcome. The authors found moderate strength evidence that more aggressive blood pressure control (SBP < 140 mm Hg) in patients with prior stroke substantially reduced rates of recurrent stroke.","Lowering blood pressure in adults over age 60 reduces mortality, stroke, and cardiac events. The most consistent and largest effects are seen in studies of patients with higher baseline blood pressures (SBP ≥ 160 mm Hg) achieving moderate blood pressure control (< 150/90 mm Hg). Lower treatment targets (< 140/85 mm Hg) are likely to be beneficial for some patients at high cardiovascular risk, but the results across trials are less consistent. Lower treatment targets are largely supported by findings from one trial which targeted SBP <120 mm Hg and in which most intervention patients achieved SBP < 130 mm Hg. In patients with cerebrovascular disease, more aggressive blood pressure lowering (SBP <140 mm Hg) likely reduces recurrent stroke. Lower treatment targets are associated with higher medication burden and an increased risk of short-term harms such as hypotension. On the other hand, evidence that there is not an increased risk in cognitive impairment, falls and reduced quality of life may provide some flexibility for providers in crafting an individualised antihypertensive treatment plan. There is little data to assess the risks and benefits of antihypertensive treatment among institutionalised elder patients or those with multiple comorbidities"]
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[null,"Community Preventive Services Task Force. Cardiovascular Disease: Self-Measured Blood Pressure Monitoring Interventions for Improved Blood Pressure Control. Task Force Findings and Rationale Statement; 2015.\nAvailable here.\n\nLast updated June 2016. ","Unspecified.","This Community Preventive Service Task Force finding is based on evidence from a systematic review published in 2013 which evaluated the effectiveness of self-measured blood pressure monitoring interventions when used alone or when combined with additional support to manage high blood pressure. For studies evaluating self-measured blood pressure monitoring alone, a meta-analysis was conducted and reported relative risks and weighted net differences across multiple time points. Because of clinical heterogeneity, however, only narrative results were reported for self-measured blood pressure monitoring combined with additional support. To better inform Task Force conclusions on health impact estimates were transformed into absolute percentage point changes and net differences using the latest time point available.\n\nThe finding of sufficient evidence of effectiveness for self-measured blood pressure monitoring interventions when implemented alone is based on evidence from 26 studies with 28 study arms. Patients in these studies received blood pressure monitoring devices, were trained to use them and shared blood pressure readings with their healthcare providers. Results demonstrated consistent and meaningful improvements in blood pressure when the intervention was compared with usual care. Results were statistically significant at the six month time point and continued to be favourable at 12 months, although smaller in magnitude.\n\nThe finding of strong evidence of effectiveness for self-measured blood pressure monitoring interventions when combined with additional support is based on evidence from 25 studies with 29 study arms. Additional support varied between studies and was categorized into three main groups: one-on-one patient counselling or telecounseling (11 studies), access to electronic or web-based tools (seven studies), and education on high blood pressure and blood pressure self-management (five studies). Half of these studies were conducted using a team-based care arrangement where health care providers worked alongside other professionals, such as nurses and pharmacists, to improve coordination of care and support for patients (14 studies with 17 study arms). Results demonstrated consistent and meaningful improvements in blood pressure that were sustained at 12 months when the intervention was compared with usual care.\n\n","The Community Preventive Services Task Force recommends self-measured blood pressure monitoring interventions to improve blood pressure outcomes in patients with high blood pressure. There is sufficient evidence of effectiveness for self-measured blood pressure monitoring interventions when used alone (i.e. patients receive self-measured blood pressure tools, training, and monitoring). There is strong evidence of effectiveness for these interventions when combined with additional support (i.e. patient counselling, education, or web-based support). The economic evidence indicates that self-measured blood pressure monitoring interventions are cost-effective when they are used with additional support or within team-based care."]
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[null,"Community Preventive Services Task Force. Cardiovascular Disease Prevention: Team based care to improve blood pressure control. Task Force Findings and Rationale Statement; 2012.\nAvailable here.\n\nLast updated July 16, 2014. ","Hypertensive patients.","This Community Preventive Services Task Force review looks at team-based care to improve blood pressure control. \n\nThe Task Force finding is based on evidence from a systematic review published in 2006 (28 studies, search period January 1980-July 2003) and a more recent Community Guide review (52 studies, search period July 2003-May 2012). Results from both reviews demonstrate the effectiveness of team-based care (TBC) in improving blood pressure outcomes.\n\nFrom the current review, the predominant team members who worked with patients and primary care providers were nurses (28 studies), pharmacists (15 studies), or both (five studies). When pharmacists were added to teams, the median improvement in the proportion of patients with controlled blood pressure was considerably higher than the overall median increase for this outcome. Median reductions in SBP and DBP were similar to overall estimates. When nurses or both nurses and pharmacists were added to teams, median estimates for all three outcomes were comparable to overall effect estimates. Only four studies examined the effectiveness of adding other team members, such as community health workers, social workers or dietitians without nurses or pharmacists. In these few instances, median effect estimates were smaller in magnitude compared to overall effect estimates. Most studies added one team member; results were similar when compared to studies that added two or more team members, for all three outcomes.\n\nStudies in the current review also examined effectiveness of TBC when team members could make changes to hypertensive medications independent of the primary care provider (16 studies); with primary care provider approval or consultation (15 studies); or not at all (22 studies). The first two levels of medication management achieved larger improvements in blood pressure outcomes when compared to the third level, where team members provided adherence support and hypertension-related information but did not make medication changes or recommendations. Other important team member roles include support for health behaviour change (e.g.  counselling sessions) and systems support mainly via telephone follow-up.","The Community Preventive Services Task Force recommends team-based care to improve blood pressure control on the basis of strong evidence of effectiveness in improving the proportion of patients with controlled blood pressure and in reducing SBP and DBP. Evidence was considered strong based on findings from 80 studies of team-based care organised primarily with nurses and pharmacists working in collaboration with primary care providers, patients and other professionals. The economic evidence indicates that team-based care is cost-effective."]
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[null,"Ebrahim  S et al. Multiple risk factor interventions for primary prevention of coronary heart disease. Cochrane Database of Systematic Reviews 2011, Issue 1. Art. No.: CD001561. DOI: 10.1002/14651858.CD001561.pub3\nAvailable here.","Adult populations with a mean age of 35 or above. General populations could include workforce populations and high risk groups, as well as subjects who did not have a high risk of developing CHD.","This Cochrane review aimed to assess the effects of multiple risk factor interventions for reducing total mortality, fatal and non-fatal events from CHD and cardiovascular risk factors among adults assumed to be without prior clinical evidence of CHD. Types of interventions included health promotion activities to achieve behaviour change. More specifically counselling or educational interventions, with or without pharmacological treatments, that aimed to alter more than one cardiovascular risk factor. \n\nOverall, 55 trials (n=163,471) were included in the review. Blood pressure change was a secondary outcome , the results are reported below:\n\nFor both systolic and DBP, 48 trials (53 arms) indicated a significant reduction favouring intervention. The weighted mean difference between intervention and control was ‐2.71 mm Hg (95% CI ‐3.49 to ‐1.93; n = 64,809) for SBP and ‐2.13 mm Hg (95% CI ‐2.67 to ‐1.58; n = 75,400) for DBP using random‐effects models. In total, 24 trials reported that patients were on medication for high blood pressure. When analysis of outcomes was confined to these trials, strong evidence of reductions in both systolic and diastolic remained. This was also seen when the analysis was confined to trials where no medication was prescribed.\n\nNot all trials reported, or were able to provide data on, blood pressure at follow up. Overall, changes in blood pressure were small. For both outcomes there was no evidence of small study bias in the trials as shown by the funnel plots.\n\n\n","Interventions using counselling and education aimed at behaviour change do not reduce total or CHD mortality or clinical events in general populations but may be effective in reducing mortality in high‐risk hypertensive and diabetic populations. Risk factor declines were modest but owing to marked unexplained heterogeneity between trials, the pooled estimates are of dubious validity. Evidence suggests that health promotion interventions have limited use in general populations. "]

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[null,null,null,"Include"]
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[null,"Gofal a rennir neu wasanaethau nad ydynt yn cael eu harwain gan feddyg"]
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[null,"Canllaw ehangach ar atal ffactorau risg ar gyfer pwysedd gwaed uchel"]
[null,"Ffynhonnell:","Cynulleidfa:","Argymhellion:"]
[null,"National Institute for Health and Care Excellence. Community pharmacies: promoting health and wellbeing. NG102. London: NICE; 2018.\nAvailable here.  \n\nUnderpinning evidence reviews:\n\nNational Institute for Health and Care Excellence. Community pharmacy: promoting health and wellbeing. Evidence reviews for providing information on health and wellbeing. Evidence review 1. NICE Guideline NG102; 2018.\nAvailable here.  \n","This guideline is for community pharmacies, local pharmaceutical committees and pharmacy organisations, commissioners of health-promoting interventions including local authorities, clinical commissioning groups and NHS England. Local professional networks, health and wellbeing boards. It may also be relevant for private and voluntary sector organisations providing health-promoting services, people working in related services, for example GP practices and out-of-hours services, members of the public. ","This guideline covers how community pharmacies can help maintain and improve people’s physical and mental health and wellbeing, including people with a long-term condition. It aims to encourage more people to use community pharmacies by integrating them within existing health and care pathways and ensuring they offer standard services and a consistent approach. It requires a collaborative approach from individual pharmacies and their representatives, local authorities and other commissioners. The guideline makes recommendations on:\n\n - Health and wellbeing hub\n - Overarching principles of good practice\n - Awareness raising and providing information\n - Advice and education\n - Behavioural support\n - Referrals and signposting\n\nRecommendation 1.4 on advice and education states that when someone uses pharmacy services to manage a long-term condition, use this as an opportunity to advise them on how to improve their general health and wellbeing. For example, follow recommendations on advice and education in NICE guidelines on: hypertension in adults for people with, or at risk of, hypertension (see the sections on lifestyle interventions and patient education and adherence to treatment). \n\n"]
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[null,"National Institute for Health and Care Excellence. Community pharmacy: promoting health and wellbeing. Evidence reviews for providing information on health and wellbeing. Evidence review 2. NICE Guideline NG102; 2018.\nAvailable here.  \n\nNational Institute for Health and Care Excellence. Community pharmacy: promoting health and wellbeing. Evidence reviews for providing information on health and wellbeing. Evidence review 3. NICE Guideline NG102; 2018.\nAvailable here.  \n\nNational Institute for Health and Care Excellence. Community pharmacy: promoting health and wellbeing. Evidence reviews for providing information on health and wellbeing. Evidence review 4. NICE Guideline NG102; 2018.\nAvailable here.  "]
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[null,"Adolygiadau systemataidd"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Steed  L et al. Community pharmacy interventions for health promotion: effects on professional practice and health outcomes. Cochrane Database of Systematic Reviews 2019, Issue 12. Art. No.: CD011207.\nAvailable here.","Pharmacy workers, including pharmacists and counter assistants; adult pharmacy users with varying health conditions including: hypertension, diabetes, cardiovascular disease and dyslipidemia. ","The aim of this Cochrane review was to assess the effectiveness and safety of health‐promotion interventions to change community pharmacy workers' professional practice and improve outcomes for users of community pharmacies.\n\nThe authors included 57 randomised trials with 16,220 participants, described in 83 reports. Most interventions were educational, or incorporated skills training. Interventions were directed at pharmacy workers (n = 8), pharmacy users (n = 13), or both (n = 36). The clinical areas most frequently studied were diabetes, hypertension, asthma, and modification of cardiovascular risk. \n\nMost studies (47 of 57) were directed towards secondary prevention of conditions, including cardiovascular disease (1 study), type 2 diabetes (10 studies), dyslipidaemia (4 studies), and hypertension (4 studies). In approximately half of these conditions the intervention was described as being focused on the pharmacy user, whilst the other half mentioned some degree of training for the community pharmacy workers. \n\nThe authors conducted subgroup analyses for different patient behaviours, clinical conditions, and generic versus specific quality of life measures. When analysing the data across studies, when there were related outcomes from the same study, the authors used the most clinically rigorous measure. For hypertension this was: systolic blood pressure followed by diastolic blood pressure. Sub‐group analyses separated by condition suggested that interventions probably improve blood pressure in hypertension (SMD ‐0.34, 95% CI ‐0.49 to ‐0.18; I2 = 18%; 4 trials; 1050 participants; moderate‐certainty evidence; Analysis 1.2). Interventions probably improve blood glucose levels in diabetes (SMD ‐0.81, 95% CI ‐1.60 to ‐0.02; I2 = 96%; 6 trials; 651 participants; moderate‐certainty evidence; Analysis 1.2), though the high level of heterogeneity is important here. Interventions probably made little or no difference for cardiovascular risk (SMD ‐0.08, 95% CI ‐0.40 to 0.24; I2 = 0%; 2 trials, 150 participants; moderate‐certainty evidence; Analysis 1.2). \n\nMost studies (35 of 57) included some level of intermediate clinical outcome. The ones measured most consistently were in asthma (9 studies), diabetes (10 studies) and cardiovascular risk (hypertension (8 studies) and dyslipidaemia (4 studies)). Health‐promotion interventions probably improve intermediate clinical outcomes slightly in pharmacy users (SMD ‐0.43, 95% CI ‐0.65 to ‐0.21; I2 = 90%; 20 trials, 3971 participants; moderate‐certainty evidence).","The findings of this review suggest that the community pharmacy is potentially a helpful setting in which to offer behavioural and health‐promotion interventions. There is evidence to suggest that such interventions probably slightly improve pharmacy user health‐related behaviour, intermediate clinical outcomes ‐ particularly for diabetes and hypertension ‐ and quality of life.\n\nSuch interventions are likely to be cost‐effective and the effects are seen across a range of clinical conditions and health‐related behaviours. Nevertheless the magnitude of the effects varies between conditions, and more effective interventions might be developed if greater consideration were given to the theoretical basis of the intervention and mechanisms for effecting behaviour change. \n\nIn summary, health‐promotion interventions in the community pharmacy context probably improve pharmacy workers' behaviour and probably have a slight beneficial effect on health‐related behaviour, intermediate clinical outcomes, and quality of life for pharmacy users."]
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[null,"de Barra  M, et al.  Pharmacist services for non‐hospitalised patients. Cochrane Database of Systematic Reviews 2018, Issue 9. Art. No.: CD013102. DOI: 10.1002/14651858.CD013102. \nAvailable here.","Individuals who received services from outpatient pharmacists. ","This review aimed to examine the effect of pharmacists' non-dispensing services on non-hospitalised patient outcomes. \n\nWe included 116 trials comprising 111 trials (39,729 participants) comparing pharmacist interventions with usual care and five trials (2122 participants) comparing pharmacist services with services from other healthcare professionals. Of the 116 trials, 76 were included in meta‐analyses. The 40 remaining trials were not included in the meta‐analyses because they each reported unique outcome measures which could not be combined. Most trials targeted chronic conditions and were conducted in a range of settings, mostly community pharmacies and hospital outpatient clinics and were mainly but not exclusively conducted in high‐income countries. Most trials had a low risk of reporting bias and about 25%‐30% were at high risk of bias for performance  detection and attrition. Selection bias was unclear for about half of the included studies. The effect of pharmacist services on blood pressure outcomes are reported below.\n\nPharmacist services targeting patients versus usual care: \n\nPercentage outside blood pressure range:\nEighteen trials (4107 participants) evaluated whether blood pressure fell outside a specified range. These trials used a mixture of systolic and DBP and a variety of target ranges, but SBP was used in the analysis if both were reported. The results indicate that those in the pharmacist groups may be less likely to have blood pressure outside the target range (odds ratio 0.40, 95% CI 0.29 to 0.55, low‐certainty evidence; I2 = 81%). The asymmetric pattern shown in the funnel plot for this meta‐analysis could be an indication of publication bias.\n\nContinuous measures of blood pressure:\nThirty‐one trials (n = 5,939) and 32 trials (n = 6,003) were included in the meta‐analyses of diastolic and SBP, respectively. On average, there was evidence that pharmacist interventions reduced DBP by −3.50 points (95% CI −5.44 to −1.56) and SBP by −5.96 points (95% CI −7.35 to −4.57) compared with usual care. In both analyses, there was evidence of statistical heterogeneity (I2 = 94% and 74%, respectively).\n","The results demonstrate that pharmacist services have varying effects on patient outcomes compared with usual care. We found no studies comparing services delivered by pharmacists with other healthcare professionals that evaluated the impact of the intervention on the six main outcome measures. The results need to be interpreted cautiously because there was major heterogeneity in study populations, types of interventions delivered and reported outcomes. There was considerable heterogeneity within many of the meta‐analyses, as well as considerable variation in the risks of bias."]
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[null,null,null,"Pharmacist services targeting patients versus other healthcare professionals:\n\nPercentage outside blood pressure range:\nThe review authors did not find any studies comparing pharmacists' non-dispensing roles targeting non-hospitalised patients with other healthcare professionals that reported on the percentage outside blood pressure range. \n\nCompared with other healthcare professionals, pharmacist services were not associated with differences in SBP (3 trials, n=1238, MD 1.31, 95% CI -6.22 to 8.84, I2=94%) and DBP (2 trials, n=959, MD -1.36, 95% CI -4.30 to 1.59, I2=86%). "]
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[null,"Laurant  M et al. Nurses as substitutes for doctors in primary care. Cochrane Database of Systematic Reviews 2018, Issue 7. Art. No.: CD001271. DOI: 10.1002/14651858.CD001271.pub3.\nAvailable here. \n\n\n","Nurses working as substitutes for doctors.","This Cochrane review aimed to investigate the impact of nurses working as substitutes for primary care doctors on: patient outcomes, processes of care and utilisation, including volume and cost. \n\nEighteen RCTs were identified which evaluated the impact of nurses working as substitutes for doctors. \n\nStudy findings suggest that care delivered by nurses, compared to care delivered by doctors, probably generates similar or better health outcomes for a broad range of patient conditions (low‐ or moderate‐certainty evidence). The results for blood pressure are described below:\n\nThree trials focusing on patients with cardiovascular disease or diabetes evaluated clinical outcomes. Meta‐analyses for blood pressure levels suggest that, compared to doctor‐led care, nurse‐led primary care probably slightly improves blood pressure outcomes for both SBP (MD ‐3.73, 95% CI ‐6.02 to ‐1.44, moderate‐certainty evidence) and DBP (MD ‐2.54, 95% CI ‐4.57 to ‐0.52, moderate‐certainty evidence). For both outcomes, data show no evidence of statistical heterogeneity (SBP: I2 = 0%, 95% CI 0 to 90; DBP: I2 = 0%). Assessment of moderate‐certainty evidence is due to high risk of bias in one of the included studies. Results did not change considerably under sensitivity analysis.\n","This review shows that for some ongoing and urgent physical complaints and for chronic conditions, trained nurses, such as nurse practitioners, practice nurses, and registered nurses, probably provide equal or possibly even better quality of care compared to primary care doctors, and probably achieve equal or better health outcomes for patients. Nurses probably achieve higher levels of patient satisfaction, compared to primary care doctors. Furthermore, consultation length is probably longer when nurses deliver care and the frequency of attended return visits is probably slightly higher for nurses, compared to doctors. Other utilisation outcomes are probably the same. The effects of nurse‐led care on process of care and the costs of care are uncertain, and we also cannot ascertain what level of nursing education leads to the best outcomes when nurses are substituted for doctors. "]
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[null,"Smith SM, et al. Shared care across the interface between primary and specialty care in management of long term conditions. Cochrane Database of Systematic Reviews 2017, Issue 2. Art. No.: CD004910. DOI: 10.1002/14651858.CD004910.pub3.\nAvailable here.","People or populations with a specific chronic disease (e.g. hypertension), primary care physicians and specialist care physicians. ","This Cochrane review aimed to determine the effectiveness of shared care health service interventions designed to improve the management of chronic disease across the primary/specialty care interface. This is an update of a previously published review. \n\nThe authors identified 42 studies of shared care interventions for chronic disease management (n = 18,859), 39 of which were RCTs, two CBAs and one an NRCT. Of these 42 studies, 41 examined complex multi‐faceted interventions and lasted from six to 24 months. Overall, review authors confidence in results regarding the effectiveness of interventions ranged from moderate to high certainty. Results showed probably few or no differences in clinical outcomes overall with a tendency towards improved blood pressure management in the small number of studies on shared care for hypertension, chronic kidney disease and stroke (mean difference (MD) 3.47, 95% confidence interval (CI) 1.68 to 5.25)(based on moderate‐certainty evidence). \n\n","This review suggests that shared care improves depression outcomes and probably has mixed or limited effects on other outcomes. Methodological shortcomings, particularly inadequate length of follow‐up, may account in part for these limited effects.  Shared care interventions for conditions other than depression should be developed within research settings, with account taken of the complexity of such interventions and awareness of the need to carry out longer studies to test effectiveness and sustainability over time. "]
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[null,"Weeks  G, et al. Non‐medical prescribing versus medical prescribing for acute and chronic disease management in primary and secondary care. Cochrane Database of Systematic Reviews 2016, Issue 11. Art. No.: CD011227. DOI: 10.1002/14651858.CD011227.pub2.\nAvailable here. ","Healthcare providers who are not medical doctors, undertaking prescribing including, nurses, optometrists, pharmacists, physician assistants, and other allied health professionals or categories not specifically mentioned whose roles meet the authors definition of non‐medical prescribing","This Cochrane review aimed to assess clinical, patient-reported and resource use outcomes of non-medical prescribing for managing acute and chronic health conditions in primary and secondary care settings compared with medical prescribing (usual care). \n\nForty-six studies were included in the review (37,337 participants); non‐medical prescribing was undertaken by nurses in 26 studies and pharmacists in 20 studies. In 45 studies non‐medical prescribing as a component of care was compared with usual care medical prescribing. A further study compared nurse prescribing supported by guidelines with usual nurse prescribing care. No studies were found with non‐medical prescribing being undertaken by other health professionals. The education requirement for non‐medical prescribing varied with country and location. \n\nNon-medical prescribing in chronic care (primary/ambulatory care):\n\nEleven ambulatory care studies (2076 participants) reporting SBP at six months showed a mean difference (MD) favouring the non‐medical prescribing group compared to usual care of ‐6.76 mm Hg (95% CI ‐8.24 to ‐5.27;), but there was considerable heterogeneity (I2 = 82%, overall effect p < 0.00001). At 12 months, 12 ambulatory care studies (4229 participants) showed a MD favouring the non‐medical prescribing group of ‐5.31 mm Hg (95% CI ‐6.46 to ‐4.16) with moderate heterogeneity (I2 = 50%, overall effect p < 0.00001). The test for subgroup differences was not significant (I2 = 56.3%, p= 0.13). \n\nThe SBP effect estimate at six months for the fixed‐effect model was MD ‐6.76 mm Hg, 95% CI ‐8.24 to ‐5.27 compared to the random‐effects estimate (MD ‐7.34 mm Hg, 95% CI ‐11.09 to ‐3.60). At 12 months the respective comparison was MD ‐5.31 mm Hg, 95% CI ‐6.46 to ‐4.16 versus MD ‐5.91 mm Hg, 95% CI ‐7.71 to ‐4.10. There was a moderate‐certainty of evidence.\n\nExcluding the cluster‐RCT at six months, the effect estimate was MD ‐6.13 mm Hg, 95% CI ‐7.83 to ‐4.44; 10 studies, 1628 participants. Excluding the cluster‐RCTs at 12 months, the effect estimate was MD ‐4.84 mm Hg, 95% CI ‐6.29 to ‐3.39; 10 studies, 2627 participants. \n\nThe subgroup analysis of four studies (695 participants) where non‐medical prescribers demonstrated a higher level of prescribing autonomy in the control of SBP showed: fixed‐effect MD ‐2.98 mm Hg, 95% CI ‐5.36 to ‐0.59; p = 0.01, compared with a random‐effects model MD ‐6.78 mm Hg, 95% CI ‐15.38 to 1.81; p = 0.12, with considerable heterogeneity I2 = 90%. \n\n\n\n","The findings suggest that non‐medical prescribers, practising with varying but high levels of prescribing autonomy, in a range of settings, were as effective as usual care medical prescribers. Non‐medical prescribers can deliver comparable outcomes for SBP, glycated haemoglobin, low‐density lipoprotein, medication adherence, patient satisfaction and health‐related quality of life. It was difficult to determine the impact of non‐medical prescribing compared to medical prescribing for adverse events and resource use outcomes due to the inconsistency and variability in reporting across studies. Future efforts should be directed towards more rigorous studies that can clearly identify the clinical, patient‐reported, resource use, and economic outcomes of non‐medical prescribing, in both high‐income and low‐income countries. "]
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[null,"Community Preventive Services Task Force. Cardiovascular Disease Prevention: Team based care to improve blood pressure control. Task Force Findings and Rationale Statement; 2012.\nAvailable here.\n\nLast updated July 16, 2014. ","Hypertensive patients.","This Community Preventive Services Task Force review looks at team-based care to improve blood pressure control. \n\nThe Task Force finding is based on evidence from a systematic review published in 2006 (28 studies, search period January 1980-July 2003) and a more recent Community Guide review (52 studies, search period July 2003-May 2012). Results from both reviews demonstrate the effectiveness of team-based care (TBC) in improving blood pressure outcomes.\n\nFrom the current review, the predominant team members who worked with patients and primary care providers were nurses (28 studies), pharmacists (15 studies), or both (five studies). When pharmacists were added to teams, the median improvement in the proportion of patients with controlled blood pressure was considerably higher than the overall median increase for this outcome. Median reductions in SBP and DBP were similar to overall estimates. When nurses or both nurses and pharmacists were added to teams, median estimates for all three outcomes were comparable to overall effect estimates. Only four studies examined the effectiveness of adding other team members, such as community health workers, social workers or dietitians without nurses or pharmacists. In these few instances, median effect estimates were smaller in magnitude compared to overall effect estimates. Most studies added one team member; results were similar when compared to studies that added two or more team members, for all three outcomes.\n\nStudies in the current review also examined effectiveness of TBC when team members could make changes to hypertensive medications independent of the primary care provider (16 studies); with primary care provider approval or consultation (15 studies); or not at all (22 studies). The first two levels of medication management achieved larger improvements in blood pressure outcomes when compared to the third level, where team members provided adherence support and hypertension-related information but did not make medication changes or recommendations. Other important team member roles include support for health behaviour change (e.g.  counselling sessions) and systems support mainly via telephone follow-up.","The Community Preventive Services Task Force recommends team-based care to improve blood pressure control on the basis of strong evidence of effectiveness in improving the proportion of patients with controlled blood pressure and in reducing SBP and DBP. Evidence was considered strong based on findings from 80 studies of team-based care organised primarily with nurses and pharmacists working in collaboration with primary care providers, patients and other professionals. The economic evidence indicates that team-based care is cost-effective."]
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[null,"Yr amser gorau posibl i asesu"]
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[null,"Adolygiadau systemataidd"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Dyakova  M, et al.  Systematic versus opportunistic risk assessment for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2016, Issue 1. Art. No.: CD010411. DOI: 10.1002/14651858.CD010411.pub2.\nAvailable here. ","Healthy adults from the general population including those who are at risk of CVD.","This Cochrane review aimed to assess the effectiveness, costs and adverse effects of systematic risk assessment compared to opportunistic risk assessment for the primary prevention of CVD. \n\nNine completed RCTs met the inclusion criteria for the review, of which four were cluster‐randomised. The authors also identified five ongoing trials. The included studies had a high or unclear risk of bias, and the GRADE ratings of overall quality were low or very low. Blood pressure change was a secondary outcome for the review, the results are reported below: \n\nSix studies reported SBP at follow‐up and were combined in a meta‐analysis. Mean SBP was lower in the intervention group compared with the control group (MD ‐3.05 mm Hg, 95% CI ‐4.84 to ‐1.25; participants = 12,591; studies = 6; I² = 82%; very low‐quality evidence). There was considerable statistical heterogeneity, so review auhtors combined the data with a random‐effects model. Sensitivity analysis suggested that BFHS 1994 had a considerable impact on the results. Removing this study from the analysis reduced statistical heterogeneity to 0% and reduced uncertainty, as demonstrated by a narrower confidence interval. The mean difference, although slightly less, remained statistically significant (MD ‐1.91 mm Hg, 95% CI ‐2.67 to ‐1.16; participants = 10,584; studies = 5; I² = 0%). \n\nSix studies reported DBP at follow‐up and were combined in a meta‐analysis. Mean DBP was lower in the intervention group compared with the control group (MD ‐1.34 mm Hg, 95% CI ‐1.76 to ‐0.93; participants = 12,591; studies = 6; I² = 0%; low‐quality evidence). ","The results are limited by the heterogeneity between trials in terms of participants recruited, interventions and duration of follow‐up. Limited data suggest that systematic risk assessment for CVD has no statistically significant effects on clinical endpoints. There is limited evidence to suggest that CVD systematic risk assessment may have some favourable effects on cardiovascular risk factors. The completion of the five ongoing trials will add to the evidence base. "]
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[null,"Gweithredu technoleg"]
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[null,"Adolygiadau systemataidd"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Flodgren  G, et al. Interactive telemedicine: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD002098. DOI: 10.1002/14651858.CD002098.pub2.\nAvailable here. ","Participants with any chronic condition (including those with hypertension).","This Cochrane review aimed to assess the effectiveness, acceptability and costs of interactive telemedicine as an alternative, or in addition to, usual care (i.e. face-to-face care or telephone consultation). \n\nNinety-three trials were included in the review (n=22,047 participants) which evaluated the effectiveness of interactive telemedicine delivered in addition to (32% of studies), as an alternative to (57% of studies), or partly substituted for usual care (11%) as compared to usual care alone. Four studies were in participants with hypertension.\n\nIn the studies assessing telemedicine in patients with hypertension, blood pressure measurement varied among studies at follow‐up. One study (n = 387) reported a greater decrease in mean SBP in telemedicine delivered care in addition to usual care, as compared with usual care alone at 12 months; one study (n = 236) reported no differences in diastolic daytime and night time ambulatory blood pressure (ABPM) between groups at six months but did report that a greater proportion of intervention patients achieved a target BP at six months. One study (n = 121) reported a greater decrease in 24‐hour systolic and diastolic ABPM and a greater change in mean BP in the telemedicine group at eight weeks, as compared with control. In one monitoring study with automated review of data with alerts (n = 329), the authors reported a greater proportion of telemedicine participants achieving daytime normalisation of arterial BP as compared with control.","The findings in our review indicate that the use of telemedicine in the management of heart failure appears to lead to similar health outcomes as face‐to‐face or telephone delivery of care; there is evidence that telemedicine can improve the control of blood glucose in those with diabetes. The cost to a health service and acceptability by patients and healthcare professionals, is not clear due to limited data reported for these outcomes. The effectiveness of telemedicine may depend on a number of different factors, including those related to the study population e.g. the severity of the condition and the disease trajectory of the participants, the function of the intervention e.g., if it is used for monitoring a chronic condition, or to provide access to diagnostic services, as well as the healthcare provider and healthcare system involved in delivering the intervention."]
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[null,"de Jongh  T, et al. Mobile phone messaging for facilitating self‐management of long‐term illnesses. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD007459. DOI: 10.1002/14651858.CD007459.pub2.\nAvailable here. ","All study participants regardless of age, gender, ethnicity, and type and stage of disease.","This Cochrane review aimed to assess the effects of mobile phone messaging applications designed to facilitate self-management of long-term illnesses on health outcomes and patients' capacity to self-manage their condition. \n\nFour RCTs (reported in seven papers) were included in the review. One of these studies looked at patients with hypertension, and compared systolic and DBP in groups of patients with and without text message support, at baseline and one, three and six months after initiation of the study. Blood pressure levels at six months were comparable in the two groups (SBP MD 1.10, 95% CI ‐4.37 to 6.57); DBP MD 1.84, 95% CI ‐2.14 to 5.82). Achievement of good blood pressure control (as defined by having blood pressure less than 140/90 mm Hg in patients without diabetes and 130/85 mm Hg in patients with diabetes) at the end of the study was not statistically different between the control and intervention groups (RR of not achieving blood pressure control 0.73, 95% CI 0.41 to 1.29). The body weight of the participants at six months was also comparable between groups (MD ‐ 2.76 (95% CI ‐8.17 to 2.65). For all of the reported outcome measures the evidence is considered to be of moderate quality only, due to the small number of patients enrolled in the trial. The observed effect sizes are likely to be affected by further research.\n\n","The authors conclude that there was some very limited indications that in certain cases mobile phone messaging interventions may provide benefit in supporting the self‐management of long‐term illnesses. However, there are significant information gaps regarding the long‐term effects, acceptability, costs, and risks of such interventions. Given the enthusiasm with which so‐called mHealth interventions are currently being implemented, further research into these issues is needed.  "]
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[null,"Gweithredu mewn gweithleoedd"]
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[null,"Adolygiadau systemataidd"]
[null,"Ffynhonnell:","Poblogaeth:","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Brunton G et al. Developing evidence-informed, employer-led workplace health. London: EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London; 2016. Available here.","Male NHS employees","One included study (Lomas and McCluskey, 2005) aimed to evaluate the effectiveness of a workplace health promotion initiative. Blood screening was taken into the workplace setting for all staff members who wished to take part.\n\nThis study examined the perceptions of male NHS workers across a range of worksites who took part in a blood pressure screening intervention. The authors were interested in men’s perceptions of the experience and the impact of screening on men’s health decision-making processes, and they aimed to identify ways to improve the intervention. Semi-structured interviews were conducted with workers and managers, and thematic analysis undertaken. The overall usefulness rating for this study was high. The sample covered a broad range of work roles in the NHS, and the intervention, which was specifically targeted towards men, resulted in a successful outcome. By offering blood pressure screening on site, the male participants were more likely to take an interest in their own health. Other factors which encouraged participation were the professionalism of the deliverer, the effort made with regard to the welfare of the recruits, and external and internal support.","The overall review (synthesis of views studies (n=10) and policy report (n=14) suggests that 'managerial support’ is a key mechanism for the successful implementation of workplace health. Characteristics relate to all levels of managerial roles/responsibilities and are applicable to companies of different sizes and scales. Key points have been highlighted:\n- Managers could encourage staff to participate in workplace health, e.g. web-based health programmes, blood pressure screenings, weight management or mental health\ninitiatives, or could support employees’ career progression.\n- Managers could provide ongoing support and ‘follow up’: follow up, such as reminders and communication about workplace health, is perceived as leading to ongoing commitment from staff."]

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[null,null,null,"Include"]
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[null,"Canllaw ehangach ar atal ffactorau risg ar gyfer pwysedd gwaed uchel"]
[null,"Ffynhonnell:","Cynulleidfa:","Argymhellion:"]
[null,"National Institute for Health and Care Excellence. Physical activity: encouraging activity in the community. QS183. London: NICE; 2019. Available here. ",null,"This quality standard covers how local strategy, policy and planning and improvements to the built or natural physical environment such as public open spaces, workplaces and schools can encourage and support people of all ages and all abilities to be physically active and move more. It describes high-quality care in priority areas for improvement.\n\n - Statement 1. Local authorities and healthcare commissioning groups have senior level physical activity champions who\n   are responsible for developing and implementing local strategies, policies and plans. \n\n - Statement 2. Local authorities prioritise pedestrians, cyclists and people who use public transport when developing and\n   maintaining connected travel routes.\n\n - Statement 3. Local authorities involve community members in designing and managing public open spaces. \n\n - Statement 4. Workplaces have a physical activity programme to encourage employees to move more and be more \n   physically active.\n\n - Statement 5. Schools and early years settings have active travel plans that are monitored and updated annually.\n"]
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[null,"National Institute for Health and Care Excellence. Community pharmacies: promoting health and wellbeing. NG102. London: NICE; 2018.\nAvailable here.  \n\nUnderpinning evidence reviews:\n\nNational Institute for Health and Care Excellence. Community pharmacy: promoting health and wellbeing. Evidence reviews for providing information on health and wellbeing. Evidence review 1. NICE Guideline NG102; 2018.\nAvailable here.  \n","This guideline is for community pharmacies, local pharmaceutical committees and pharmacy organisations, commissioners of health-promoting interventions including local authorities, clinical commissioning groups and NHS England. Local professional networks, health and wellbeing boards. It may also be relevant for private and voluntary sector organisations providing health-promoting services, people working in related services, for example GP practices and out-of-hours services, members of the public. ","This guideline covers how community pharmacies can help maintain and improve people’s physical and mental health and wellbeing, including people with a long-term condition. It aims to encourage more people to use community pharmacies by integrating them within existing health and care pathways and ensuring they offer standard services and a consistent approach. It requires a collaborative approach from individual pharmacies and their representatives, local authorities and other commissioners. The guideline makes recommendations on:\n\n - Health and wellbeing hub\n - Overarching principles of good practice\n - Awareness raising and providing information\n - Advice and education\n - Behavioural support\n - Referrals and signposting\n\nRecommendation 1.4 on advice and education states that when someone uses pharmacy services to manage a long-term condition, use this as an opportunity to advise them on how to improve their general health and wellbeing. For example, follow recommendations on advice and education in NICE guidelines on: hypertension in adults for people with, or at risk of, hypertension (see the sections on lifestyle interventions and patient education and adherence to treatment). \n\n"]
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[null,"National Institute for Health and Care Excellence. Community pharmacy: promoting health and wellbeing. Evidence reviews for providing information on health and wellbeing. Evidence review 2. NICE Guideline NG102; 2018.\nAvailable here.  \n\nNational Institute for Health and Care Excellence. Community pharmacy: promoting health and wellbeing. Evidence reviews for providing information on health and wellbeing. Evidence review 3. NICE Guideline NG102; 2018.\nAvailable here.  \n\nNational Institute for Health and Care Excellence. Community pharmacy: promoting health and wellbeing. Evidence reviews for providing information on health and wellbeing. Evidence review 4. NICE Guideline NG102; 2018.\nAvailable here.  "]
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[null,"Scottish Intercollegiate Guidelines Network (SIGN). Risk estimation and the prevention of cardiovascular disease. SIGN 149. Edinburgh: SIGN; 2017. \nAvailable here. ","This guideline will be of interest to healthcare professionals involved in the management of patients with\ncardiovascular disease including cardiologists, dietitians, general practitioners, lipidologists, pharmacists,\nphysiotherapists, practice nurses, psychologists and public health staff, as well as patients, carers, voluntary\norganisations and policy makers.","This guideline deals with the management of cardiovascular risk, both primary prevention, defined as the potential for an intervention prior to the disease presenting through a specified event (any incident linked to critical disruption of blood flow that may cause damage to the heart, brain or peripheral tissues), and secondary prevention, defined as the potential for intervention after an event has occurred. \n\nThe guideline provides recommendations on estimation of cardiovascular risk and interventions to reduce this risk in people with and without established cardiovascular disease (CVD). The guideline does not make specific recommendations for the management of people with chronic heart failure, acute coronary syndrome, stable angina or cardiac arrhythmias as these are contained within other SIGN guidelines.\n\nThe guideline includes sections on blood pressure (BP) thresholds, selection of antihypertensive therapy and the British Hypertension Society algorithm (for the selection of drug therapy). \n\nThe guideline recommends that:\n\n - Individuals with uncomplicated hypertension should be supported to achieve a BP target of <140/90 mmHg (clinic measurement)\n - For individuals with established CVD and diabetes, chronic renal disease or target organ damange a lower blood pressure target of <135/85 mmHg (clinic measurement) should be considered\n - Lowering BP below 130/80 mmHg is not routinely recommended as this brings limited additional benefits and causes significant adverse effects\n\n\n"]
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[null,"National Institute for Health and Care Excellence. Obesity in adults: prevention and lifestyle weight management programmes. QS111. London: NICE; 2016. \nAvailable here. ",null,"This quality standard addresses one of the upstream risk factors of hypertension; obesity. Background information in the quality statement states that \"The National Audit Office report Tackling obesity in England estimated that women who are obese are around 13 times more likely to develop type 2 diabetes and 4 times more likely to develop hypertension than women who are not obese. Men who are obese are estimated to be around 5 times more likely to develop type 2 diabetes and 2.5 times more likely to develop hypertension than men who are not obese.\"\n\nThe list of quality statements include:\n\n - Statement 1. Adults using vending machines in local authority and NHS venues can buy healthy food and drink options\n - Statement 2. Adults see details of nutritional information on menus at local authority and NHS venues \n - Statement 3. Adults see healthy food and drink choices displayed prominently in local authority and NHS venues \n - Statement 4. Adults have access to a publicly available, up‑to‑date list of local lifestyle weight management programmes\n - Statement 5. Adults can access data on attendance, outcomes and views of participants and staff from locally commissioned lifestyle weight management programmes \n - Statement 6. Adults identified as being overweight or obese are given information about local lifestyle weight management programmes\n - Statement 7. Adults identified as overweight or obese, with comorbidities are offered a referral to a lifestyle weight management programme\n - Statement 8. Adults about to complete a lifestyle weight management programme agree a plan to prevent weight regain\n"]
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[null,"National Institute for Health and Care Excellence. Preventing excess weight gain. NG7. London: NICE; 2015. \nAvailable here. \n\nUnderpinning evidence review: \n\nBazian Ltd, Johnson L, Sebire S. Maintaining a healthy weight and preventing excess weight gain in children and adults - partial update of CG43. Evidence review 1: An evidence review of modifiable diet and physical activity components, and associated behaviours. London: Bazian, 2014.  \nAvailable here. \n\nBazian Ltd, Johnston L, Sebire S. Maintaining a healthy weight and preventing excess weight gain in children and adults - partial update of CG43. Evidence review 2: Qualitative evidence review of the most acceptable ways to communicate information about individually modifiable behaviours to help maintain a healthy weight or prevent excess weight gain. London: Bazian; 2014.\nAvailable here. \n\n","This guideline is for commissioners and practitioners and members of the public. ","This guideline covers behaviours such as diet and physical activity to help children (after weaning), young people and adults maintain a healthy weight or help prevent excess weight gain. The aim is to prevent a range of diseases and conditions including cardiovascular disease and type 2 diabetes and improve mental wellbeing.\n\nThe guideline makes recommendations on:\n\n - How to encourage people to make changes in line with existing advice\n - How to encourage physical activity and a diet that reduces the risk of excess energy intake\n - Further advice for parents and carers of children and young people\n - How to encourage adults to limit the amount of alcohol they drink\n - How to clearly communicate the benefits of making gradual improvements to physical activity and dietary habits\n - How to tailor messages for specific groups\n - How to ensure activities are integrated with the local strategic approach to obesity\n\nRecommendation 7 advises clearly communicating the broad range of benefits of maintaining a healthy weight through being more physically active and improving dietary habits. These include the reduced risk of developing diseases associated with excess weight such as coronary heart disease, hypertension, liver disease, osteoarthritis, stroke, type 2 diabetes and some cancers. \n"]
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[null,"National Institute for Health and Care Excellence. Weight management: lifestyle services for overweight or obese adults. PH53. London: NICE; 2014. \nAvailable here.\n\nUnderpinning evidence reviews:\n\nHartmann-Boyce J et al. Managing overweight and obesity in adults: update review. The clinical effectiveness of long-term weight management schemes for adults (Review 1a). Oxford: University of Oxford; 2013. \nAvailable here.  ","This guideline is for commissioners, health professionals, providers of lifestyle weight management programmes and adults who are overweight or obese, their families and other members of the public. ","This guideline covers multi-component lifestyle weight management services including programmes, courses, clubs or groups provided by the public, private and voluntary sector. The aim is to help people lose weight and become more physically active to reduce the risk of diseases associated with obesity. This includes coronary heart disease, stroke, type 2 diabetes and various cancers.\n\nThis guideline includes recommendations on:\n\n - How to adopt an integrated approach to preventing and managing obesity\n - Awareness-raising among commissioners, health and social care staff and the public\n - Improve programme uptake, adherence and outcomes\n - Monitoring and evaluation\n"]
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[null,"Hartmann-Boyce J et al. How components of behavioural weight management programmes affect weight change. Review 1b. Oxford: University of Oxford; 2013. \nAvailable here."]
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[null,"Johns D et al. Weight regain after behavioural weight management programmes. Review 1c. Oxford: University of Oxford; 2013. \nAvailable here. "]
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[null,"Johns D et al. Managing overweight and obese adults: evidence review. Review 2. Oxford: University of Oxford; 2013. \nAvailable here. "]
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[null,"National Institute for Health and Care Excellence. Physical activity: exercise referral schemes PH54. London: NICE; 2014. \nAvailable here.\n\nUnderpinning evidence reviews:\n\nCampbell F et al. A systematic review and economic evaluation of exercise referral schemes in primary care: a short report. Sheffield; University of Sheffield school of health and related research; 2013.\nAvailable here.\n\nMorgan F et al. The factors that influence referral to, attendance at and successful completion of exercise schemes and longer term participation in physical activity. Cardiff; Support Unit for Research Evidence (SURE), Cardiff University; 2013.\nAvailable here.","This guideline is for policy makers and commissioners in local authorities and the NHS, primary care practitioners and other practitioners with physical activity as part of their remit. Providers of exercise referral schemes, organisations that provide exercise qualifications and accreditiation, and members of the public. ","This guideline covers exercise referral schemes for people aged 19 and older, in particular, those who are inactive or sedentary. The aim is to encourage people to be physically active.\n\nThis guideline includes recommendations on:\n\n - Exercise referral for people who are sedentary or inactive but otherwise healthy\n - Exercise referral for people who are sedentary or inactive and have a health condition or other health risk factors\n"]
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[null,"National Institute for Health and Care Excellence. Behaviour change: individual approaches PH49, London; NICE. 2014. \nAvailable here.\n\nUnderpinning evidence review:\n\nBazian Ltd. Individual-level behaviour change. External evidence review 1: review of current NICE guidance and recommendations. Bazian; 2012. \nAvailable here.\n\nBazian Ltd. Individual-level behaviour change. External evidence review 2: review of evidence of effectiveness of interventions and behaviour change techniques in individual level interventions. Bazian; 2013. \nAvailable here. \n\nBazian Ltd. Individual-level behaviour change. External evidence review 3: A qualitative review of studies describing the characteristics and competencies needed for behaviour change interventions or techniques. Bazian; 2013.\nAvailable here. ","This guideline is for healthcare professionals, commissioners and providers, young people, adults, their families and carers. ","This guideline covers changing health-damaging behaviours among people aged 16 and over using interventions such as goals and planning, feedback and monitoring, and social support. It aims to help tackle a range of behaviours including alcohol misuse, poor eating patterns, lack of physical activity, unsafe sexual behaviour and smoking. Hypertension is not specifically mentioned but the guideline is applicable for tackling some of the risk factors for hypertension such as lack of physical activity, diet and alcohol misuse. \n\nThis guideline includes recommendations on: \n\n - Developing local behaviour change policy and strategy\n - Commissioning interventions\n - Planning interventions that take account of local needs\n - Ensuring interventions meet individual needs\n - Delivering interventions\n - Commissioning and providing training\n - Monitoring and evaluating interventions\n"]
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[null,"National Institute for Health and Care Excellence. Type 2 diabetes prevention: population and community-level interventions PH35. London: NICE; 2011. \nAvailable here. \n\nUnderpinning evidence review: \n\nNational Institute for Health and Care Excellence. Preventing type 2 diabetes: population and community-level interventions. Evidence update October 2014. London; NICE, 2014. \nAvailable here. ","This guideline is for directors and commissioners, GPs, practice nurses, dietitians and public health nutritionists and other health professionals. Practitioners involved in physical activity interventions and community engagement and members of the public. ","This guideline covers preventing type 2 diabetes in adult populations and communities who are at high risk. It aims to promote a healthy diet and physical activity at community and population level, and recommends how to tailor services for people in ethnic communities and other groups who are particularly at risk of type 2 diabetes.\n\nThis guideline includes recommendations on:\n\n - Integrating national strategy on non-communicable diseases\n - Local joint strategic needs assessments and developing a local strategy\n - Interventions for communities at high risk of type 2 diabetes\n - Conveying messages to the local and whole population\n - Promoting a healthy diet: local and national action\n - Promoting physical activity: local and national action\n - Training those involved in promoting healthy lifestyles\n\n\n"]
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[null,"National Institute for Health and Care Excellence. Cardiovascular disease prevention PH25. London: NICE, 2010.\nAvailable here. \n\nUnderpinning evidence reviews:\n\nNational Institute for Health and Care Excellence. Prevention of cardiovascular disease. Evidence update January 2014. London: NICE, 2014. \nAvailable here. ","This guideline is for national government, NHS and local authorities, industry, commissioners, managers and practitioners working in the above and in the wider public, private, voluntary and community sections, and members of the public. ","This guideline covers the main risk factors linked with CVD:  poor diet, physical inactivity, smoking and excessive alcohol consumption. It aims to reduce the high incidence of CVD. This, in turn, will help prevent other major causes of death and illness, such as type 2 diabetes and many cancers.\n\nThis guideline includes recommendations for policy: a national framework for action and recommendations for practice. Topics covered include:\n\n - How to reduce the nation’s consumption of salt, saturated fats and trans fats\n - Commercial interests\n - Product labelling\n - Public sector catering guidelines\n - Regional CVD prevention programmes\n - Health impact assessments of regional and local plans and policies\n - Take-aways and other food outlets\n\nThe guidance is intended to complement other NICE guidance, including guidance on hypertension.\n\nIn the underpinning evidence review update, one key point states that \"Local policies to reduce intake of salt from foods provided by the public sector might result in fewer cases of hypertension, and corresponding decreases in direct healthcare costs\". It states that \"reducing UK salt intake by 3g/day might prevent approximately 10,000 deaths and 10,000 non-fatal cardiovascular events each year. This would exceed benefits from smoking cessation programmes, weight loss interventions in individuals, and statins. Reduction in salt intake by as little as 1 g/day may be more cost effective than blood pressure-lowering drugs\". \n\nThe underpinning review update also states that \"sugar-sweetened drinks may be associated with an increased risk of incident hypertension, though causality is uncertain. Evidence that artificially sweetened drinks might also be associated with hypertension is conflicting\", however this is not covered within the guideline. "]
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[null,"National Institute for Health and Care Excellence. Alcohol-use disorders: prevention. PH24. London: NICE, 2010. \nAvailable here. \n\nUnderpinning evidence reviews:\n\nNational Institute for Health and Care Excellence. Alcohol-use disorders: preventing harmful drinking. Evidence update March 2014. London: NICE, 2014. \nAvailable here.","This guideline is for commissioners, managers and practitioners working in local authorities, the NHS, education and the wider public, private, voluntary and community sectors, and members of the public.","This guideline covers alcohol problems among people over 10. It aims to prevent and identify such problems as early as possible using a mix of policy and practice. Hypertension is not addressed in this guideline, however alcohol misuse is an upstream risk factor for hypertension. \n\nThis guideline includes recommendations on:\n\n - Price, availability and marketing\n - Licensing\n - Supporting children and young people aged 10 to 15 years \n - Screening young people aged 16 and 17 years and offering them extended brief interventions\n - Screening adults and offering them brief advice and interventions\n - Referral\n"]
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[null,"Scottish Intercollegiate Guidelines Network. Management of Obesity: A national clinical guideline. SIGN 115. Edinburgh: SIGN; 2010. \nAvailable here. ","This guideline will be of particular interest to those working in primary care, secondary and\ntertiary NHS weight management services and those involved in management of services for long term conditions especially diabetes and cardiovascular disease. It will help provide direction for planning at local and national levels and will also be of interest to voluntary sector and commercial weight loss organisations, to patients and the general public.","This SIGN clinical guideline updates and supersedees the previous SIGN guidelines on obesity in adults (SIGN 8,1996) and obesity in children and young people (SIGN 69, 2003). Sections 3-15 focus on adult obesity and sections 16-19 cover childhood obesity. This guideline provides evidence based recommendations on the prevention and treatment of obesity within the clinical setting, in children, young people and adults. The focus of prevention is on primary prevention, defined here as intervention when individuals are at a healthy weight and/or overweight to prevent or delay the onset of obesity. \n\nThe guideline addresses:\n\n\u0083\u0083 - Primary prevention of obesity in children, young people and adults\n\u0083\u0083 - Treatment of overweight/obesity by diet and lifestyle interventions\n\u0083\u0083 - Treatment of obesity by pharmacological therapy and bariatric surgery\n\u0083\u0083 - Prevention of weight regain following treatment\n\nThe guideline recommends that healthcare professionals shoud make patients aware of the health benefits associated with sustained modest weight loss, including reduced blood pressure. \n\nThe guideline states that Weight cycling is associated with increased risk of hypertension in obese women. There was\nno adverse effect of weight cycling on hypertension in overweight middle aged men and adverse effects on hypertension in overweight women did not reach statistical significance. Patients should be encouraged to make sustainable lifestyle changes and given support to avoid weight cycling. \n\n"]
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[null,"National Institute for Health and Care Excellence. Cardiovascular disease: identifying and supporting people most at risk of dying early. PH15. London: NICE; 2008.\nAvailable here. ","This guideline is for health and social care practitioners, organisations planning, providing or supporting services that support disadvantaged people, adults with a high risk of heart disease, their families and carers and the general public. ","This guideline covers the risk of early death from heart disease and other smoking-related illnesses. It aims to reduce the number of people who are disadvantaged dying prematurely by ensuring people have better access to flexible, well-coordinated treatment and support.\n\nThis guideline includes recommendations on:\n\n - Identifying adults at risk of early death from heart disease\n - Improving access to services\n - Ensuring services work together\n - Training for staff\n"]
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[null,"National Institute for Health and Care Excellence. Behaviour change: general approaches PH6. London: NICE; 2007.\nAvailable here.\n\nUnderpinning evidence review:\n\nJepson et al. A review of the effectiveness of interventions, approaches and models at individual, community and population level that are aimed at changing health outcomes through changing knowledge attitudes and behaviour. Stirling: University of Stirling: 2006. Available here.","This guideline is for national policy makers, commissioners, providers and practitioners in the NHS, local authorities and the community and voluntary sectors. Researchers, including those who oversee research funding. Social and behavioural scientists, and health economists working on health-related knowledge, attitude and behaviour change.\n","This guideline covers a set of principles that can be used to help people change their behaviour. The aim is for practitioners to use these principles to encourage people to adopt a healthier lifestyle by, for example, stopping smoking, adopting a healthy diet and being more physically active. The guidance does not specifically address hypertension, but is addressing behaviour change interventions for reducing some of the upstream risk factors of hypertension (such as lack of physical activity). \n\nThis guideline recommends a set of principles to use as the basis for:\n\n - Providing education and training for those delivering them\n - Delivery of these activities, including one-to-one and community-based programmes and those aimed at specific populations\n - Evaluation of their effectiveness and cost effectiveness\n"]
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[null,"National Institute for Health and Care Excellence. Obesity Prevention. CG43. London: NICE; 2006. \nAvailable here. \n\nLast updated March 2015.","This guideline is for healthcare professionals, commissioners and providers, employers, local authorities, primary care trusts, head teachers and chairs of governors, children, young people and adults, and their families and carers. ","This guideline covers preventing children, young people and adults becoming overweight or obese. It outlines how the NHS, local authorities, early years’ settings, schools and workplaces can increase physical activity levels and make dietary improvements among their target populations.\n\nThis guideline includes recommendations on:\n\n - Strategies for senior managers and budget holders in the NHS\n - Interventions by healthcare professionals\n - Strategies for senior managers and budget holders in local authorities\n - Interventions by local authorities\n - Interventions in early years’ settings and by teachers\n - Strategies for head teachers and chairs of governors\n - Interventions in workplaces\n"]
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[null,null,null,"Adolygiadau systemataidd"]
[null,"Ffynhonnell:","Poblogaeth","Canfyddiadau:","Casgliadau’r awduron:"]
[null,"Chastin  S, et al. Interventions for reducing sedentary behaviour in community‐dwelling older adults. Cochrane Database of Systematic Reviews 2021, Issue 6. Art. No.: CD012784. DOI: 10.1002/14651858.CD012784.pub2. Accessed 07 September 2021.\nAvailable here","Older adults (aged 60 or over) living independently in the community. Participants having multiple comorbidities were included, but the authors excluded interventions that recruited clinical populations specifically (e.g. stroke survivors).","The aim of this Cochrane review was to evaluate the effectiveness of interventions aimed at reducing sedentary behaviour amongst older adults living independently in the community compared to control conditions involving either no intervention or interventions that do not target sedentary behaviour.\nThe evidence suggests that interventions to change sedentary behaviour in community‐dwelling older adults may reduce sedentary time (mean difference (MD) −44.91 min/day, 95% confidence interval (CI) −93.13 to 3.32; 397 participants; 7 studies; I2 = 73%; low‐certainty evidence). The authors could not pool evidence on the effect of interventions on breaks in sedentary behaviour or time spent in specific domains such as TV time, as data from only one study were available for these outcomes.\nThe authors are uncertain whether interventions to reduce sedentary behaviour have any impact on the physical or mental health outcomes of community‐dwelling older adults. They were able to pool change data for the following outcomes:\nBlood pressure: systolic (MD −3.91 mmHg, 95% CI ‐10.95 to 3.13; 138 participants; 3 studies; I2 = 73%; very low‐certainty evidence) and diastolic (MD −0.06 mmHg, 95% CI −5.72 to 5.60; 138 participants; 3 studies; I2 = 97%; very low‐certainty evidence).","It is not clear whether interventions to reduce sedentary behaviour are effective at reducing sedentary time in community‐dwelling older adults. The authors are uncertain if these interventions have any impact on the physical or mental health of community‐dwelling older adults. There were few studies, and the certainty of the evidence is very low to low, mainly due to inconsistency in findings and imprecision.\nFuture studies should consider interventions aimed at modifying the environment, policy, and social and cultural norms. Future studies should also use device‐based measures of sedentary time, recruit larger samples, and gather information about quality of life, cost‐effectiveness, and adverse event data.\n"]
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[null,"Lee  L-L, et al. Walking for hypertension. Cochrane Database of Systematic Reviews 2021, Issue 2. Art. No.: CD008823. DOI: 10.1002/14651858.CD008823.pub2.\nAvailable here.","General population, aged from 16 to 84 years (approximately 1.5 times as many females as males). ","This systematic review sought to determine the effect of walking as a physical activity intervention on blood pressure and heart rate.\nThe authors included 73 trials, with 5763 participants in total; studies were undertaken in 22 countries. The majority of walking interventions were at home/community (n = 50) but supervised (n = 36 out of 47); the average intervention length was 15 weeks, average walking time per week was 153 minutes and the majority of walking intensity was moderate.\nThe authors found moderate‐certainty evidence suggesting that walking reduces systolic blood pressure (SBP) (MD ‐4.11 mmHg, 95% CI ‐5.22 to ‐3.01; 73 studies, n = 5060). They found moderate‐certainty evidence suggesting that walking reduces SBP in participants aged 40 years and under (MD ‐4.41 mmHg, 95% CI ‐6.17 to ‐2.65; 14 studies, n = 491), and low‐certainty evidence that walking reduces SBP in participants aged 41 to 60 years (MD ‐3.79 mmHg, 95% CI ‐5.64 to ‐1.94, P < 0.001; 35 studies, n = 1959), and those aged 60 years of over (MD ‐4.30 mmHg, 95% CI ‐6.17 to ‐2.44, 24 studies, n = 2610). The authors also found low certainty‐evidence suggesting that walking reduces SBP in both females (MD ‐5.65 mmHg, 95% CI ‐7.89 to ‐3.41; 22 studies, n = 1149) and males (MD ‐4.64 mmHg, 95% CI ‐8.69 to ‐0.59; 6 studies, n = 203).\nThe authors found low‐certainty evidence suggesting that walking reduces diastolic blood pressure (DBP) (MD ‐1.79 mmHg, 95% CI ‐2.51 to ‐1.07; 69 studies, n = 4711) and heart rate (MD ‐2.76 beats per minute (bpm), 95% CI ‐4.57 to ‐0.95; 26 studies, n = 1747). They found moderate‐certainty evidence suggesting that walking reduces DBP for participants aged 40 years and under (MD ‐3.01 mmHg, 95% CI ‐4.44 to ‐1.58; 14 studies, n = 491) and low‐certainty evidence suggesting that walking reduces DBP for participants aged 41 to 60 years (MD ‐1.74 mmHg, 95% CI ‐2.95 to ‐0.52; 32 studies, n = 1730) and those aged 60 years and over (MD ‐1.33 mmHg, 95% CI ‐2.40 to ‐0.26; 23 studies, n = 2490). The authors found moderate‐certainty evidence that suggests walking reduces DBP for males (MD ‐2.54 mmHg, 95% CI ‐4.84 to ‐0.24; 6 studies, n = 203) and low‐certainty evidence that walking reduces DBP for females (MD ‐2.69 mmHg, 95% CI ‐4.16 to ‐1.23; 20 studies, n = 1000). Only 21 included studies reported adverse events. Of these 21 studies, 16 reported no adverse events, the remaining five studies reported eight adverse events, with knee injury being reported five times.","Moderate‐certainty evidence suggests that walking probably reduces SBP. Moderate‐ or low‐certainty evidence suggests that walking may reduce SBP for all ages and both sexes. Low‐certainty evidence suggests that walking may reduce DBP and heart rate. Moderate‐ and low‐certainty evidence suggests walking may reduce DBP and heart rate for all ages and both sexes."]
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[null,"Hooper  L, et al. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database of Systematic Reviews 2020, Issue 8. Art. No.: CD011737. DOI: 10.1002/14651858.CD011737.pub3. Available here.","Adults (18 years or older), with and without cardiovascular disease.","The authors sought to assess the effect of reducing saturated fat intake and replacing it with carbohydrate (CHO), polyunsaturated (PUFA), monounsaturated fat (MUFA) and/or protein on mortality and cardiovascular morbidity.\nThey included trials that used a variety of interventions from providing all food to advice on reducing saturated fat. The included long‐term trials suggested that reducing dietary saturated fat reduced the risk of combined cardiovascular events by 17% (risk ratio (RR) 0.83; 95% confidence interval (CI) 0.70 to 0.98, 12 trials, 53,758 participants of whom 8% had a cardiovascular event, I² = 67%, GRADE moderate‐quality evidence). Meta‐regression suggested that greater reductions in saturated fat (reflected in greater reductions in serum cholesterol) resulted in greater reductions in risk of CVD events, explaining most heterogeneity between trials. The number needed to treat for an additional beneficial outcome (NNTB) was 56 in primary prevention trials, so 56 people need to reduce their saturated fat intake for four years for one person to avoid experiencing a CVD event. In secondary prevention trials, the NNTB was 53. Subgrouping did not suggest significant differences between replacement of saturated fat calories with polyunsaturated fat or carbohydrate, and data on replacement with monounsaturated fat and protein was very limited. \n\nThe authors found little or no effect of reducing saturated fat on all‐cause mortality (RR 0.96; 95% CI 0.90 to 1.03; 11 trials, 55,858 participants) or cardiovascular mortality (RR 0.95; 95% CI 0.80 to 1.12, 10 trials, 53,421 participants), both with GRADE moderate‐quality evidence. \n\nThere was little or no effect of reducing saturated fats on non‐fatal myocardial infarction (RR 0.97, 95% CI 0.87 to 1.07) or CHD mortality (RR 0.97, 95% CI 0.82 to 1.16, both low‐quality evidence), but effects on total (fatal or non‐fatal) myocardial infarction, stroke and CHD events (fatal or non‐fatal) were all unclear as the evidence was of very low quality. There was little or no effect on cancer mortality, cancer diagnoses, diabetes diagnosis, HDL cholesterol, serum triglycerides or blood pressure, and small reductions in weight, serum total cholesterol, LDL cholesterol and BMI. There was no evidence of harmful effects of reducing saturated fat intakes.","The findings of this updated review suggest that reducing saturated fat intake for at least two years causes a potentially important reduction in combined cardiovascular events. Replacing the energy from saturated fat with polyunsaturated fat or carbohydrate appear to be useful strategies, while effects of replacement with monounsaturated fat are unclear. \nThe reduction in combined cardiovascular events resulting from reducing saturated fat did not alter by study duration, sex or baseline level of cardiovascular risk, but greater reduction in saturated fat caused greater reductions in cardiovascular events."]
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[null,"Steed  L et al. Community pharmacy interventions for health promotion: effects on professional practice and health outcomes. Cochrane Database of Systematic Reviews 2019, Issue 12. Art. No.: CD011207.\nAvailable here.","Pharmacy workers, including pharmacists and counter assistants; adult pharmacy users with varying health conditions including: hypertension, diabetes, cardiovascular disease and dyslipidemia. ","The aim of this Cochrane review was to assess the effectiveness and safety of health‐promotion interventions to change community pharmacy workers' professional practice and improve outcomes for users of community pharmacies.\n\nThe authors included 57 randomised trials with 16,220 participants, described in 83 reports. Most interventions were educational, or incorporated skills training. Interventions were directed at pharmacy workers (n = 8), pharmacy users (n = 13), or both (n = 36). The clinical areas most frequently studied were diabetes, hypertension, asthma, and modification of cardiovascular risk. \n\nMost studies (47 of 57) were directed towards secondary prevention of conditions, including cardiovascular disease (1 study), type 2 diabetes (10 studies), dyslipidaemia (4 studies), and hypertension (4 studies). In approximately half of these conditions the intervention was described as being focused on the pharmacy user, whilst the other half mentioned some degree of training for the community pharmacy workers. \n\nThe authors conducted subgroup analyses for different patient behaviours, clinical conditions, and generic versus specific quality of life measures. When analysing the data across studies, when there were related outcomes from the same study, the authors used the most clinically rigorous measure. For hypertension this was: systolic blood pressure followed by diastolic blood pressure. Sub‐group analyses separated by condition suggested that interventions probably improve blood pressure in hypertension (SMD ‐0.34, 95% CI ‐0.49 to ‐0.18; I2 = 18%; 4 trials; 1050 participants; moderate‐certainty evidence; Analysis 1.2). Interventions probably improve blood glucose levels in diabetes (SMD ‐0.81, 95% CI ‐1.60 to ‐0.02; I2 = 96%; 6 trials; 651 participants; moderate‐certainty evidence; Analysis 1.2), though the high level of heterogeneity is important here. Interventions probably made little or no difference for cardiovascular risk (SMD ‐0.08, 95% CI ‐0.40 to 0.24; I2 = 0%; 2 trials, 150 participants; moderate‐certainty evidence; Analysis 1.2). \n\nMost studies (35 of 57) included some level of intermediate clinical outcome. The ones measured most consistently were in asthma (9 studies), diabetes (10 studies) and cardiovascular risk (hypertension (8 studies) and dyslipidaemia (4 studies)). Health‐promotion interventions probably improve intermediate clinical outcomes slightly in pharmacy users (SMD ‐0.43, 95% CI ‐0.65 to ‐0.21; I2 = 90%; 20 trials, 3971 participants; moderate‐certainty evidence).","The findings of this review suggest that the community pharmacy is potentially a helpful setting in which to offer behavioural and health‐promotion interventions. There is evidence to suggest that such interventions probably slightly improve pharmacy user health‐related behaviour, intermediate clinical outcomes ‐ particularly for diabetes and hypertension and quality of life.\n\nSuch interventions are likely to be cost‐effective and the effects are seen across a range of clinical conditions and health‐related behaviours. Nevertheless the magnitude of the effects varies between conditions, and more effective interventions might be developed if greater consideration were given to the theoretical basis of the intervention and mechanisms for effecting behaviour change. \n\nIn summary, health‐promotion interventions in the community pharmacy context probably improve pharmacy workers' behaviour and probably have a slight beneficial effect on health‐related behaviour, intermediate clinical outcomes, and quality of life for pharmacy users. "]
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[null,"Harris J, Felix L, Miner A, Murray E, Michie S. Adaptive e-learning to improve dietary behaviour: a systematic review and cost-effectiveness analysis. Health Technology Assessment 2011;15(37)\nAvailable here.","Adults","The most commonly used behavioural change techniques reported to have been used were: goal setting; feedback on performance; information on consequences of behaviour in general; barrier identification/problem solving; prompting self-monitoring of behaviour; and instruction on how to perform the behaviour.\n\nThere was substantial heterogeneity in the estimates of effect. E-learning interventions were associated with a WMD of +0.24 (95% CI 0.04 to 0.44) servings of fruit and vegetables per day; -0.78 g (95% CI -2.5 g to 0.95 g) total fat consumed per day; -0.24 g (95% CI -1.44 g to 0.96 g) saturated fat intake per day; -1.4% (95% CI -2.5% to -0.3%) of total energy consumed from fat per day; +1.45 g (95% CI -0.02 g to 2.92 g) dietary fibre per day; +4 kcal (95% CI -85 kcal to 93 kcal) daily energy intake; -0.1 kg/m2 (95% CI -0.7 kg/m2 to 0.4 kg/m2) change in body mass index.\n\nFor blood pressure change as an outcome, the combined summarised result for the two studies focussed on systolic blood pressure was WMD 0.39 (mmHg) ranging between (−3.23 to 4.01) when using 95% CI. For diastolic blood pressure the summarised WMD was -0.30 (mmHg) ranging between (-0.49 to -0.11) when using 95% CI. ","There are many factors affecting what foods people eat and why, and an intervention targeted\nat individual behaviour change can address only a selection of these. E-learning has not yet\nproved itself to be more effective or cost-effective than other behaviour change approaches at an\nindividual level for improving diet, or for preventing or reducing overweight or obesity. Nor is\nthere any research comparing e-learning approaches with population-level approaches to tackling\ndietary change or reducing obesity."]
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[null,"Campbell F, Holmes M, Everson-Hock E, Davis S, Buckley Woods H, Anokye N, et al. A systematic review and economic evaluation of exercise referral schemes in primary care: A short report. Health Technology Assessment 2015;19(60)\nAvailable here.\n\nReport based on:\nPavey T, Anokye N, Taylor A, Trueman P, Moxham T. The clinical effectiveness and cost-effectiveness of exercise referral schemes: a systematic review and economic \nevaluation.  Health Technology Assessment 2011;15(44)\nAvailable here.","Adults","This report is based on the 2011 systematic review by Pavey et al.\n\nThe proportion of individuals achieving 90–150 minutes of at least moderate-intensity activity per week at 6–12 months’ follow-up was greater for ERSs than usual care (relative risk 1.12; 95% confidence interval 1.04 to 1.20). \nOlder patients and those referred for CHD risk factors appeared to be more likely than others to increase their levels of physical activity. Qualitative evidence suggests that interventions enabling the development of social support networks are beneficial in promoting uptake and adherence. \nReferral to an ERS did not lead to changes in objective measures of health such as weight or blood pressure.","Exercise referral schemes result in a small improvement in the number of people who increase their levels of physical activity. \nThe cost-effectiveness analysis indicates that the ICER for ERSs compared with usual care is around £76,000 per QALY, although the cost-effectiveness of ERSs is subject to considerable uncertainty.\nThere was no evidence that\nthe interventions lead to positive changes in body fat, BMI or blood pressure."]