Therapy: Clinical Scenario

You see a 75 year old patient referred to you by his GP because of raised blood pressure. His past medical history is remarkable for mild asthma but he is otherwise well. His GP has enclosed a note stating that the patient's blood pressure has been 160-190/80-90 for the past 3 months. The patient's wife is on an ACE-I and has had no adverse effects and the patient wondered if he could take it as well. You explain to the patient that evidence from trials suggest that diuretics and beta blockers should be used as the initial treatment strategy because they are known to decrease the risk of stroke. The patient asks to look at this evidence with you. You formulate the question, "In patients with isolated systolic hypertension, do diuretics decrease the risk of stroke and death?"

You start up Best Evidence, enter "hypertension" and "stroke" and you find the abstract and commentary for the randomised controlled trial assessing the prevention of stroke with antihypertensive therapy. The abstract and commentary look helpful so you decide to go to the library and copy the original article( JAMA 1991;265:3255-64. ). You make a follow-up appointment with your patient and tell him that you will discuss the evidence with him at that time.

Read the article and decide:

1. Is the evidence from this randomised trial valid?
2. If valid, is this evidence important?
3. If valid and important, can you apply this evidence in caring for your patient?

Continue to completed worksheet