Author Affiliations: Department of Medicine (Drs Hunt and Jaeschke and Ms McKibbon) and Health Information Research Unit (Dr Hunt and Ms McKibbon), McMaster University, Hamilton, Ontario.
Users' Guides to the Medical Literature Section
Editor: Drummond Rennie, MD, Deputy Editor (West).
You are a general internist reviewing the condition of a 55-year-old
woman with type 2 diabetes mellitus and hypertension. Her glycemic control
is excellent with metformin, and she has no history of complications. To manage
her hypertension, she takes a small daily dose of a thiazide diuretic. During
the examination, you note that her weight is stable, she has no evidence of
peripheral neuropathy, and her blood pressure is 155/88 mm Hg. After arranging
for glycosylated hemoglobin, cholesterol, and microalbumin assessments, you
reassure your patient that she is doing well and ask her to return in 3 months.
After she has left, you notice that her blood pressure over the past 6 months
has been about the same as it was today. You wonder if she would benefit from
more aggressive blood pressure control. Specifically, in this patient with
diabetes mellitus, would tighter blood pressure control improve survival or
delay the onset of complications? You decide to find if the medical literature
can help resolve the issue.
Hunt DL, Jaeschke R, McKibbon KA, for the Evidence-Based Medicine Working Group . Users' Guides to the Medical LiteratureXXI. Using Electronic Health Information Resources in Evidence-Based Practice. JAMA. 2000;283(14):1875-1879. doi:10.1001/jama.283.14.1875