An inter-arm difference in systolic BP can predict cardiovascular morbidity and all-cause mortality after 10 years in patients with hypertension, a UK study in the BMJ has found. This cohort study was carried out in a rural general practice setting in Devon. It analysed 230 patients receiving treatment for hypertension; 47 of whom had cardiovascular disease at recruitment. The authors conclude that differences in systolic BP between arms can predict an increased risk of cardiovascular events and all-cause mortality over 10 years in patients with hypertension. They suggest that this could be used as another indicator of increased cardiovascular risk and furthermore that BP measurement on both arms should be performed as a matter of routine in primary care. ‘Assessment of BP in both arms is recommended by guidelines and should become a core component of initial BP measurement in primary care,’ the authors state.

Being male or having diabetes confers a poorer prognosis in patients with heart failure, a large meta-analysis in the European Journal of Heart Failure has shown. The authors used data from 31 studies in the Meta-Analysis Global Group In Chronic Heart Failure (MAGGIC) of 41,949 patients with heart failure of which 28,052 were men and 13,897 women. Dr Peter Savill GP Watercress Medical, Medstead, GPwSI Cardiology, Southampton, writes: 'The authors note that women with ischaemic heart failure present more like men probably because the effect of an acute event such as a myocardial infarction negates the degree of protection from being female unlike the more gradual process of a non-ischaemic cardiomyopathy. Furthermore, diabetes patients with heart failure are known to have a poorer prognosis and again less of a gender effect is seen.'

Primary care teams can make a valuable contribution to counselling, testing and treatment for HIV, a systematic review has shown. This review was limited by various factors. However, it does show that there are no adverse clinical outcomes for HIV counselling, testing and treatment in primary care; also, cost-effectiveness studies were largely in favour. Comments Dr Richard Ma, GP with an interest in sexual health, North London 'The time has come to consider moving to a shared-care model for HIV. However, the challenge of breaking down stigma so that people with HIV disclose their status to their primary healthcare team still remains a barrier for good care in the UK.'

A large meta-analysis has shown that statins are just as effective in women as in men for reducing cardiovascular events and all-cause mortality. The analysis included 141,235 patients, 40,275 of whom were women, from studies such as JUPITER, ALLHAT-LLT, ASCOT-LLA, the Heart Protection Study, PROVE-IT and TNT. The trials included were a mixture of primary and secondary prevention studies. 'This study supports the notion that statins are a beneficial intervention in both primary and secondary prevention and that this effect holds true for both sexes,' comments Dr Peter Savill, GP Watercress Medical, Medstead, GPwSI Cardiology, Southampton.

The potential cardiovascular benefits of aspirin are outweighed by the risk of nontrivial bleeding in people without cardiovascular disease (CVD), a meta-analysis has shown. The researchers analysed nine randomised placebo-controlled trials reporting on cardiovascular disease, non-vascular outcomes or death. Each trial contained at least 1,000 participants, mean age at baseline was 57 years and 46% of participants were men.

Accelerated partner therapy (APT) strategies do appear to expedite partner treatment compared with routine partner notification (PN), a UK-based study has found. The trial involved two urban genitourinary medicine (GUM) clinics: one in central London and another outside London where it is the sole GUM service.  Dr Ma considers the messages this of this study for general practice.

Leisure time exercise and low to moderate physical activity at work are associated with a reduced risk of myocardial infarction (MI), a large international study across different economic regions has shown. Earlier research had found a link between physical activity during leisure time and cardiovascular disease but the association with work-related activity was less clear. INTERHEART is a case-control study of more than 29,000 people from 52 countries in Europe, Asia, the Middle East, Africa, Australia, and North and South America. Peter Savill comments, 'The take-home message for our patients is clear: the best way to avoid the coronary care unit is to engage in regular physical activity. More importantly, benefits can be seen with even a small daily duration of exercise with any activity being better than none. In a world of spiralling healthcare costs this is an easy and cost-effective intervention which should further empower us in the battle against sedentary lifestyles.'

Regular routine check ups on women fitted with intrauterine contraceptive devices (IUD) do not appear to confer any protection against adverse events, a UK general practice-based study has found. The medical records of women registered with one practice in Rugby, Warwickshire who had had an IUD fitted between 1976 and 2005 were examined. Only women who had a device in place for at least two years with a complete set of legible records covering the time between insertion and removal or study endpoint (March 2007) were included in this retrospective analysis.

The mortality rate from opioid analgesics has increased fourfold over the past decade in the United States, a national study, published in JAMA, has found. Reviewing the study, Dr Jez Thompson concludes, 'This paper clearly identifies rapid growth in the prescribing of opioid analgesics in the United States over the past decade, with a large parallel increase in related morbidity and mortality, leading the authors to claim that death from prescribed opioid pain relievers is now "an epidemic". Prescribers in the UK need to remain acutely aware of the dangers of prescribed opioid analgesics, while safeguarding legitimate access to treatment. This paper echoes current clinical guidance and recommends use of opioid analgesics only in carefully screened and monitored patients when non-opioid treatments have not been effective.

Impaired glucose tolerance, low HDL cholesterol and age > 35 were the strongest predictors of developing diabetes in women with gestational diabetes mellitus (GDM), a study from Vienna has found. Commenting on the study, Dr Chris Barclay, GP with an interest in O&G, Suffolk, writes: ' The development of type 2 diabetes appears to be a continuously progressive process which can last for years or even decades. The metabolic stress of pregnancy appears to unmask this tendency temporarily, even though most women will become euglycaemic after delivery. The underlying metabolic disorder for many of these women will however continue to progress. GDM is an independent risk factor for diabetes. The opportunities for timely intervention and prevention here are obvious. Primary care is best placed to offer this help.'

Current guidelines advise treating paroxysmal AF in the same way as sustained AF but the evidence is weak, with only one retrospective analysis comparing the risk of stroke in patients with paroxysmal AF vs chronic AF (analysis of the SPAF trials, performed 15 years ago and limited to patients treated with aspirin). The ACTIVE W trial showed that warfarin is more effective than aspirin plus clopidogrel for the prevention of vascular events (stroke, embolism, MI and vascular death) in patients with AF. A recent substudy of this trial looked at the risk of stroke in 1,202 patients with paroxysmal AF compared with 5,495 with sustained AF, and the effectiveness of thromboprophylaxis in these patients. ' This substudy has shown that the risk of stroke is similar, irrespective of whether AF is paroxysmal or sustained, and that anticoagulation therapy is equally effective in both groups. Other factors, such as age and cardiovascular comorbidity, remain central to the ultimate choice of thromboprophylaxis in these patients.'