Evidence for Primary Care: the latest evidence from the Trip Database

NICE

How should hypertension in adults be diagnosed, assessed, treated and monitored?

Clinical bottom line: Diagnose hypertension with clinic blood pressure plus ABPM or HBPM confirmation, then treat with lifestyle measures and stepwise drug therapy according to blood pressure level, age, risk, and comorbidity.

Brief summary: This NICE guideline recommends confirming raised clinic blood pressure with ambulatory or home monitoring, assessing cardiovascular risk and target organ damage, and offering lifestyle advice to all. Drug treatment is recommended for persistent stage 2 hypertension and for selected people with stage 1 hypertension. Treatment is stepped up according to response, with lower clinic blood pressure targets for most adults under 80 than for those aged 80 and over.

Tools for Practice

What are the benefits and harms of lower systolic blood pressure targets in hypertension?

Clinical bottom line: Lowering SBP to <130 mmHg reduces cardiovascular events (≈5.3% vs 7.1%; NNT ~59) but increases adverse effects (≈7.2% vs 5.4%; NNH ~56).

Brief summary: Meta-analysis of large RCTs shows that more intensive SBP targets (<120–130 mmHg vs <140–150 mmHg) reduce cardiovascular events and likely mortality, but increase adverse events such as hypotension and electrolyte abnormalities. Absolute benefits and harms are similar in magnitude, with no meaningful impact on quality of life. Benefits appear consistent across patient groups, but require additional medications and careful blood pressure measurement. Decisions should balance cardiovascular risk reduction against side-effect burden and patient preferences.

NIHR

Does self-monitoring of blood pressure and proteinuria improve detection and management of hypertension in pregnancy?

Clinical bottom line: Self-monitoring of blood pressure in pregnancy is safe and acceptable but does not improve diagnosis or blood pressure control; self-testing for proteinuria is reasonably accurate and may be suitable for clinical use.

Brief summary: This programme of studies, including two large RCTs, found that self-monitoring of blood pressure during pregnancy is feasible, acceptable, and cost-neutral, but does not improve hypertension detection, blood pressure control, or maternal/perinatal outcomes compared with usual care. In contrast, self-testing for proteinuria showed good accuracy (sensitivity ~71%, specificity ~89%) and was acceptable to patients, suggesting potential for integration into care pathways.

Age Ageing

Do collaborative medication reviews during acute primary care admissions improve outcomes in older adults with polypharmacy?

Clinical bottom line: In older adults with polypharmacy, collaborative medication reviews during acute admissions do not improve quality of life or clinical outcomes despite increasing medication changes.

Brief summary: This randomised controlled trial in older adults (≥70 years, ≥6 medications) found that structured, collaborative medication reviews during acute primary care admissions did not improve health-related quality of life, physical or cognitive function, healthcare use, or mortality at 16 weeks compared with usual care. Although more medication changes occurred during admission, these differences did not persist after discharge, suggesting that one-off reviews in acute settings may be insufficient without ongoing, longitudinal management.

Diabetes Obes Metab.

Do behavioural economics–based financial incentives and social feedback improve glycaemic control in newly diagnosed type 2 diabetes?

Therapeutics Initiative

Do single-enantiomer proton pump inhibitors (e.g. esomeprazole, dexlansoprazole) offer clinical benefits over standard PPIs?

Clinical bottom line: Single-enantiomer PPIs do not provide meaningful clinical benefit over standard PPIs but increase effective dose and cost.

Brief summary: This review of head-to-head trials found no consistent clinical advantage of esomeprazole over omeprazole or dexlansoprazole over lansoprazole when equivalent doses are compared. Apparent benefits were largely due to biased comparisons using higher doses. In practice, use of single-enantiomer PPIs increases total acid-suppressive exposure and healthcare costs without improved outcomes. Long-term high-dose PPI use should be avoided unless clearly indicated.

Tools for Practice

Does testosterone improve sexual function in pre- or post-menopausal women?

ACE Clinical Guideline

How should mild to moderate atopic dermatitis (eczema) be diagnosed and managed?

Clinical bottom line: Mild–moderate atopic dermatitis is best managed with regular moisturisers plus topical anti-inflammatory treatment (first-line topical corticosteroids), alongside trigger avoidance and patient education; most cases can be effectively controlled in primary care.

Brief summary: This clinical guideline emphasises that atopic dermatitis is a chronic relapsing condition requiring ongoing management rather than cure. Diagnosis is clinical, based on itch, dry skin, and typical patterns. Core management includes liberal, regular moisturiser use, topical corticosteroids for flares, and alternatives (calcineurin inhibitors or PDE4 inhibitors) when needed. Education, trigger avoidance, and adherence are essential. Proactive intermittent treatment can reduce recurrent flares, while oral corticosteroids should generally be avoided. Most patients can be managed in primary care, with referral for refractory, severe, or complicated disease.

Diabetes Obes Metab

In type 2 diabetes inadequately controlled on triple oral therapy, is adding a fourth drug more effective than increasing metformin dose?

J Am Coll Cardiol

Is single-pill low-dose triple therapy as effective as standard-dose monotherapy for mild-to-moderate hypertension?

Clinical bottom line: Single-pill ultra–low-dose triple therapy provides blood pressure reduction similar to amlodipine and greater than losartan, with comparable short-term safety.

Brief summary: In two phase III randomised trials, a single-pill combination of low-dose amlodipine, losartan, and chlorthalidone achieved similar systolic blood pressure reductions to amlodipine monotherapy and greater reductions than losartan over 8 weeks. Blood pressure control rates were comparable or better, and adverse events were similar across groups. These findings support low-dose combination therapy as an effective and well-tolerated initial treatment option for mild-to-moderate hypertension.

Diabetes Obes Metab

Do GLP-1 receptor agonists or SGLT2 inhibitors improve outcomes when added to insulin in type 1 diabetes?

Clinical bottom line: Adjunctive GLP-1 receptor agonists and SGLT2 inhibitors modestly improve glycaemic control and weight in type 1 diabetes, but SGLT2 inhibitors increase the risk of diabetic ketoacidosis.

Brief summary: This systematic review and meta-analysis found that adding GLP-1 receptor agonists or SGLT2 inhibitors to insulin in type 1 diabetes leads to modest reductions in HbA1c, insulin requirements, and body weight, with improved time-in-range. GLP-1 receptor agonists were generally well tolerated (mainly gastrointestinal side effects), with low rates of severe hypoglycaemia or DKA. SGLT2 inhibitors showed similar metabolic benefits but were associated with a significantly increased risk of diabetic ketoacidosis. Overall, benefits are modest and must be weighed against safety concerns, particularly DKA risk with SGLT2 inhibitors.

Age Ageing

Do antimuscarinic drugs for overactive bladder increase the risk of cognitive decline, cardiovascular disease, or mortality in women?

Clinical bottom line: Antimuscarinics for overactive bladder may be associated with increased long-term risks of dementia, cardiovascular events, and mortality in older women, although evidence is largely observational and uncertain.

Brief summary: This systematic review found no short-term cognitive effects in small RCTs, but observational studies suggest increased risks of cognitive decline or dementia, cardiovascular disease, and mortality with antimuscarinic use in older women. The evidence is limited by potential bias and confounding, but raises concern about cumulative anticholinergic burden. Clinicians should weigh potential benefits against possible long-term harms, particularly in older patients.

JAMA Netw Open

Does a pharmacist-led deprescribing service reduce opioid and benzodiazepine use and falls in older adults?

Clinical bottom line: A pharmacist-led deprescribing service is feasible but does not significantly reduce opioid or benzodiazepine use or falls over 1 year.

Brief summary: In this cluster randomised trial of older adults in primary care, a consultant pharmacist intervention providing tapering recommendations did not significantly reduce opioid or benzodiazepine prescribing, discontinuation rates, or falls compared with usual care. Although prescribing decreased modestly in both groups and the intervention was well accepted, the effect was not clinically meaningful overall, suggesting that more intensive or sustained deprescribing strategies are likely needed.