Vol 15 - Nov 2025 Evidence for Primary Care
Evidence for Primary Care: the latest evidence from the Trip Database
A summary of some of the most important new documents for primary care that have recently been added to the Trip Database
Breathe Easy, Aim Low, and Think Smart: This Month in Evidence
This week’s headline act is blood pressure—specifically, the virtues of aiming low. Targeting a systolic BP under 120 mm Hg offers a modest improvement in overall quality of life, the kind you notice only when you stop and think, “Actually… I do feel a bit better.” And for older adults, starting intensive BP control early delivers better long-term cardiovascular outcomes, reinforcing that in hypertension—as in tidying the garage—doing it now beats doing it later.
Breathing strategies also step into the spotlight. They’re simple, unflashy, and unlikely to win any awards, but pursed-lip breathing and other techniques do provide small improvements in dyspnoea and quality of life for those with chronic lung disease. Sometimes the best interventions truly are the low-tech ones that help you breathe a little easier.
GLP-1 receptor agonists make three appearances this week, and they’re clearly keen to prove they’re more than glucose-lowering workhorses. One review finds they modestly improve cognitive function, another shows they reduce dementia risk, and a third highlights their ability to lower cardiovascular events and mortality—while remaining broadly well-tolerated. Taken together, the trio suggests GLP-1s are shaping up to be multitaskers for both mind and heart, not just metabolism.
The rest of the edition ranges from teenage dieting dilemmas to teledermatology and chronic pain interventions. But the main message? A deeper breath, a lower systolic target, and perhaps a GLP-1 or two may each offer a small but meaningful lift.
In This Edition
- Does targeting systolic blood pressure <120 mm Hg, compared with <140 mm Hg, improve quality of life in high–cardiovascular-risk patients?
- Does early and sustained intensive blood pressure control improve long-term cardiovascular outcomes in older adults with hypertension?
- Do non-pharmacological breathing strategies reduce dyspnoea and improve quality of life in adults with stable chronic lung disease?
- Do GLP-1 receptor agonists improve cognitive function in adults with type 2 diabetes?
- Which antidiabetic agents reduce the risk of dementia in people with type 2 diabetes?
- What are the risks of dieting during adolescence, and how should health professionals respond?
- Is the FIBROWALK multicomponent therapy effective for reducing fibromyalgia severity when delivered online or outdoors?
- Does teledermatology improve the management of primary care dermatology referrals?
- Does comprehensive cardiovascular screening reduce mortality in men aged 60–64?
- Is escitalopram more effective or safer than citalopram?
- Do GLP-1 receptor agonists reduce cardiovascular events and mortality, and how well are they tolerated across different patient populations?
- In primary care, is brief trauma-focused psychotherapy more effective than SSRIs for PTSD, and what is the best next step when patients do not respond to an SSRI?
- How effective is peripheral nerve stimulation for managing chronic pain based on randomized controlled trial evidence?
- Does vitamin D supplementation reduce mortality, cardiovascular disease, or cancer in adults?
J Am Coll Cardiol.
Does targeting systolic blood pressure <120 mm Hg, compared with <140 mm Hg, improve quality of life in high–cardiovascular-risk patients?
Clinical bottom line: Intensive systolic blood pressure lowering to below 120 mm Hg provides a small but statistically significant improvement in overall health-related quality of life compared with a target below 140 mm Hg, with no meaningful differences across specific quality-of-life domains.
Summary: In the ESPRIT randomized trial of more than 10,800 high-risk hypertensive patients followed for 3.4 years, intensive blood pressure treatment led to a slight increase in EQ-5D visual analog scale scores, whereas scores declined in the standard-treatment group, producing a modest net benefit. Rates of categorical change across the EQ-5D domains were similar between groups, indicating that the improvement was limited to overall perceived health rather than specific functional areas.
View ArticleJ Am Coll Cardiol.
Does early and sustained intensive blood pressure control improve long-term cardiovascular outcomes in older adults with hypertension?
Clinical Bottom Line: In older adults with hypertension, initiating and maintaining intensive systolic BP control (110–<130 mmHg) provides greater long-term cardiovascular benefit than delaying intensive therapy, with only a small increase in hypotension risk.
Summary: In older adults with hypertension, maintaining intensive systolic BP control (110–<130 mmHg) over six years led to fewer cardiovascular events than switching to intensive control later, with only hypotension occurring more often. Earlier initiation produced the greatest benefit, and delaying intensive treatment reduced but did not eliminate the cardiovascular advantage.
View ArticleJ Physiother.
Do non-pharmacological breathing strategies reduce dyspnoea and improve quality of life in adults with stable chronic lung disease?
Clinical Bottom Line: Breathing techniques such as pursed-lip breathing and breathing retraining may modestly reduce dyspnoea and improve quality of life in adults with chronic lung disease, although the certainty of evidence is low.
Brief Summary: A systematic review of 15 trials found low-quality evidence that non-pharmacological breathing strategies can provide small to moderate improvements in symptoms and quality of life for people with stable chronic lung disease. Pursed-lip breathing may lessen dyspnoea within the first three months, and breathing retraining may improve quality of life over longer periods, but true effect sizes remain uncertain.
View ArticleDiabetes Obes Metab.
Do GLP-1 receptor agonists improve cognitive function in adults with type 2 diabetes?
Clinical Bottom Line: In adults with type 2 diabetes, GLP-1 receptor agonists appear to produce modest but statistically significant improvements in cognitive function compared with placebo or conventional therapy. Benefits are greater with long-term treatment (≥24 weeks) and may support earlier initiation when cognitive impairment is a concern. While improvements in MMSE and MoCA scores are small, they are consistent across trials and suggest a potential neuroprotective effect that may complement glycaemic management.
Brief summary: This systematic review and meta-analysis of 18 RCTs including over 11,000 participants found that GLP-1 receptor agonists modestly improved MMSE and MoCA scores in adults with type 2 diabetes. Longer treatment duration strengthened the effect, suggesting potential neuroprotective benefits. Overall study quality was good, and findings were consistent across sensitivity analyses.
View ArticleDiabetes Obes Metab.
Which antidiabetic agents reduce the risk of dementia in people with type 2 diabetes?
Clinical bottom line: SGLT2 inhibitors, GLP-1 receptor agonists, thiazolidinediones, and DPP-4 inhibitors are each associated with a reduced risk of dementia in type 2 diabetes, with SGLT2 inhibitors showing the greatest relative benefit. Insulin use is associated with an increased dementia risk, and metformin and sulfonylureas show no clear effect.
Brief summary: This systematic review and network meta-analysis included 67 studies involving over four million people with type 2 diabetes. The analysis compared nine classes of antidiabetic drugs and found that SGLT2 inhibitors had the strongest association with reduced dementia risk, followed by GLP-1 receptor agonists, thiazolidinediones, and DPP-4 inhibitors. Insulin was the only class linked to a higher risk of dementia, while metformin, sulfonylureas, glinides, and α-glucosidase inhibitors showed no significant association.
View ArticleCanadian Paediatric Society.
What are the risks of dieting during adolescence, and how should health professionals respond?
Clinical bottom line: Dieting in adolescence is common and strongly associated with harmful physical, psychological, and long-term outcomes—including nutrient deficiencies, growth delay, binge eating, weight gain, depression, and increased risk of eating disorders. A weight-neutral, health-focused approach is recommended, with careful screening for disordered eating and avoidance of weight-biased messaging.
Brief summary: This Canadian Paediatric Society statement highlights that many adolescents diet despite being at a healthy weight, often driven by body dissatisfaction, social pressures, and weight-related messaging from peers, family, media, and health care settings. Dieting frequently involves unhealthy practices such as skipping meals, fasting, or adopting restrictive fad diets, and is linked to nutrient deficiencies, menstrual irregularities, impaired growth, psychological distress, and higher risk of later eating disorders. Evidence also shows that dieting typically predicts long-term weight gain rather than loss. The statement urges clinicians to avoid weight-focused counselling, address their own weight biases, promote balanced eating and positive body image, routinely screen for disordered eating, and support healthy behaviours rather than weight loss goals.
View ArticleJ Pain.
Is the FIBROWALK multicomponent therapy effective for reducing fibromyalgia severity when delivered online or outdoors?
Clinical bottom line: Both online and outdoor versions of the FIBROWALK program reduce fibromyalgia severity more than usual care, with around one-third of patients achieving meaningful improvement. The online version shows some sustained benefit at 6 months, while the outdoor version does not.
Brief summary: In this randomized controlled trial of 225 adults with fibromyalgia, participants received either online FIBROWALK, outdoor FIBROWALK, or treatment as usual for 12 weeks. Both versions significantly reduced fibromyalgia severity at the end of the program, with similar effectiveness. At 6-month follow-up, only the online format maintained a significant advantage over usual care. About 36–37% of participants in both intervention groups achieved clinically meaningful improvement post-intervention, with ~20% maintaining it at follow-up. Reduced psychological inflexibility and kinesiophobia partly explained the longer-term benefits. Low dropout rates and minimal adverse effects suggest both formats are feasible, with the online version offering scalable delivery.
View ArticleHealth Information and Quality Authority
Does teledermatology improve the management of primary care dermatology referrals?
Clinical bottom line: Store-and-forward teledermatology can safely reduce unnecessary face-to-face dermatology visits, improve triage speed, and is likely cost-saving when integrated into existing referral pathways, provided image quality and digital systems are adequate.
Brief summary: This HTA found that teledermatology offers moderate to high agreement with in-person dermatology for diagnosis and management, avoids a substantial proportion of clinic visits, and can shorten time to treatment. Safety concerns were minimal and similar to standard care. Economic analyses suggest it can reduce overall costs and help address long waiting lists. Effective implementation requires good imaging, consistent electronic referrals, and clear GP–dermatologist workflows.
View ArticleEur Heart J.
Does comprehensive cardiovascular screening reduce mortality in men aged 60–64?
Clinical bottom line: In this large Danish trial, invitation to broad CT-based cardiovascular screening did not reduce all-cause mortality or major cardiovascular events over seven years, but it did increase serious bleeding, likely due to downstream preventive treatments. Longer follow-up is needed.
Brief summary: DANCAVAS II randomized over 31,000 Danish men aged 60–64 to invitation to cardiovascular screening or no invitation. Only 63% of those invited were screened. After seven years, mortality and major cardiovascular events were similar between groups, with no significant benefit from screening. However, severe bleeding—particularly gastrointestinal—was more frequent in the screened group. The authors note that the trial was powered for 10-year outcomes, so longer follow-up may clarify any later benefits.
View ArticleTherapeutics Initiative
Is escitalopram more effective or safer than citalopram?
Clinical bottom line: Current evidence does not show meaningful differences in efficacy or safety between escitalopram and citalopram. Escitalopram’s perceived superiority appears driven by marketing rather than clinical benefit, and citalopram is generally the more cost-effective option.
Brief summary: This systematic review examined 17 studies comparing escitalopram with citalopram for depression and anxiety. Most trials were industry-funded and at high risk of bias, yet even these did not demonstrate clinically important advantages for escitalopram in terms of symptom improvement, speed of onset, or adverse effects. Because the two SSRIs perform similarly, the authors conclude that citalopram—being less expensive—is the preferred first-line choice, and that patients on escitalopram can often be switched to citalopram at an equivalent dose.
View ArticleJ Am Coll Cardiol.
Do GLP-1 receptor agonists reduce cardiovascular events and mortality, and how well are they tolerated across different patient populations?
Clinical Bottom Line: GLP-1 receptor agonists provide a meaningful reduction in all-cause and cardiovascular mortality and major cardiovascular events across high-risk populations, with consistent benefits regardless of diabetes or kidney status. These gains come with increased gastrointestinal and gallbladder adverse effects but no rise in pancreatitis, stroke, or cancer. Overall, they offer strong cardioprotection beyond glucose lowering.
Brief Summary: This meta-analysis of 21 trials including nearly 100,000 participants shows that GLP-1 receptor agonists significantly reduce deaths and major cardiovascular events with high-certainty evidence. They also lower risks of myocardial infarction, heart failure, acute kidney injury, and serious adverse events, while increasing gastrointestinal and gallbladder problems. Benefits were broadly consistent across patient subgroups and drug types, supporting GLP-1 RAs as effective cardiovascular therapies with predictable tolerability trade-offs.
View ArticleJAMA Psychiatry.
In primary care, is brief trauma-focused psychotherapy more effective than SSRIs for PTSD, and what is the best next step when patients do not respond to an SSRI?
Clinical Bottom Line: In primary care settings, both SSRIs and written exposure therapy provide meaningful reductions in PTSD symptoms with no overall difference in effectiveness. For patients who do not respond to an SSRI, switching to an SNRI appears more effective than augmenting with written exposure therapy.
Brief Summary: This pragmatic trial of 700 primary care patients compared initial treatment with SSRIs versus written exposure therapy and evaluated next-step strategies for SSRI nonresponders. Symptom improvements at four months were similar between groups despite lower engagement with psychotherapy. Among those not responding to an SSRI, switching to venlafaxine led to greater symptom reduction than adding written exposure therapy. Overall, both approaches were feasible and effective in real-world primary care, with SNRI switching offering the strongest benefit for nonresponders.
View ArticlePain Physician.
How effective is peripheral nerve stimulation for managing chronic pain based on randomized controlled trial evidence?
Clinical Bottom Line: Peripheral nerve stimulation offers a modest but clinically meaningful reduction in chronic pain for selected patients, with fair overall evidence and moderate certainty. Benefits are supported mainly for implantable systems and 60-day temporary PNS, although high-quality data remain limited.
Brief Summary: This systematic review and meta-analysis included nine randomized controlled trials evaluating peripheral nerve stimulation for chronic pain. Most studies were of moderate quality, and the overall evidence was rated as fair with moderate certainty. Across trials, PNS was associated with meaningful pain and functional improvements sustained for at least 12 months, particularly with implantable systems or temporary 60-day treatments. However, the evidence base is constrained by a small number of rigorously conducted trials, limiting stronger conclusions.
View ArticleTools for Practice
Does vitamin D supplementation reduce mortality, cardiovascular disease, or cancer in adults?
Clinical Bottom Line: Vitamin D supplementation does not reduce all-cause mortality, cardiovascular events, or cancer incidence, and the evidence for lowering cancer mortality is inconsistent, with the largest and highest-quality trials showing no benefit.
Brief Summary:
Across 11 recent systematic reviews including up to 182,000 adults, vitamin D supplements—whether taken daily or as intermittent high-dose boluses—did not reduce mortality, cardiovascular disease, or cancer incidence. Findings for cancer mortality varied, but most reviews and the largest trials showed no effect. Results were consistent regardless of baseline vitamin D status or dosing regimen, and adverse events were similar to placebo. Despite longstanding interest in vitamin D as a preventive therapy, current evidence shows no meaningful benefit for major health outcomes in typical adult populations.
