Vijaya M Musini

Overdiagnosis of bone fragility in the quest to prevent hip fracture

Despite widespread endorsement, Teppo Järvinen and colleagues argue that evidence for stratifying risk of fracture and subsequent drug therapy to prevent hip fracture is insufficient to warrant our current approach

Factors Affecting Blood Pressure Variability: Lessons Learned from Two Systematic Reviews of Randomized Controlled Trials

Systematic reviews can often reveal much more than the original objective of the work. The objectives of this retrospective analysis were to answer three basic questions about blood pressure variability: 1) Does blood pressure entry criterion have an effect on baseline blood pressure variability? 2) Do thiazide diuretics have a significant effect on blood pressure variability? and 3) Does systolic blood pressure vary to the same degree as diastolic blood pressure? This analysis of blood pressure variability is based on resting standardized research setting BP readings from two systematic reviews evaluating blood pressure lowering efficacy of thiazide diuretics from double blind randomized controlled trials in 33,611 patients with primary hypertension. The standard deviation reported in trials was the focus of the research and the unit of analysis. When a threshold systolic or diastolic blood pressure value is used to determine entry into a trial, baseline variability is significantly decreased, systolic from 14.0 to 9.3 mmHg and diastolic from 8.4 to 5.3 mmHg. Thiazides do not change BP variability as the standard deviation and coefficient of variation of systolic blood pressure and diastolic blood pressure did not differ between thiazide and placebo groups at end of treatment. The coefficient of variation of systolic blood pressure was significantly greater than the coefficient of variation of diastolic blood pressure. Entry criterion decreases the baseline blood pressure variability. Treatment with a thiazide diuretic does not affect blood pressure variability. Systolic blood pressure varies to a greater degree than diastolic blood pressure.

Statins for primary prevention

We wish to address an important issue that relates to the analysis of serious adverse events in the systematic review of statins for primary prevention by Tonelli and colleagues.[1][1] In the results section, the authors indicate “… the pooled risk of serious adverse events did not differ

Review overemphasises benefits and downplays serious harms

We recently conducted a systematic review of bisphosphonates in postmenopausal women with osteoporosis. Our critical appraisal of evidence from 33 randomised controlled trials (25 375 women) of at least one year’s duration reached different conclusions from those of Poole and Compston.1 2 The goal of treatment is prevention of fragility fractures. Effects on bone mineral …

Authors’ reply to Lee and colleagues

Lee and colleagues of the National Bone Health Alliance (NBHA) call for expanded fracture liaison services (FLS), because secondary prevention represents the most productive opportunity for pharmacotherapy. Intuitively this seems logical, but supporting arguments do not stand up to scrutiny.1 2 The effectiveness of FLS should be tested in randomised controlled trials (RCTs) to see whether this approach can achieve the “quality outcomes” referred to1—prevention of second fractures—as opposed to the proportion of patients evaluated or prescribed drugs. Presently, evidence on FLS is limited to observational studies or …

Blood pressure lowering in the oldest old: a step toward abandoning arbitrary blood pressure targets.

We read with interest the paper of Parthasarathy et al. [1], investigating the blood pressure (BP) response to two different diuretics [a mineralocorticoid receptor antagonist (MRA) and a thiazide diuretic] in patients subdivided, according to aldosterone-to-renin ratio (ARR) value, in high and low ARR group, respectively. Given the high incidence of primary aldosteronism and the widely recognized adverse effects of aldosterone on cardiovascular system, further research on MRA use in hypertensive patients is warranted.