Summary

You have just gone through the gory details of critically reading a therapeutic paper. How are you going to manage your patient? You may determine that the study design is valid and the results meaningful. Using the explicit guides described above, most readers would reach the same conclusions. The issue of applicability is where the greatest variability is likely to occur.

Now that you have gone through the painful and lengthy process, you must be asking yourself, "Surely there has to be a better (less painful) way?" Rest assured, there is! Let somebody else do the work! There are a number of secondary sources where others use the same appraisal skills we described to assess the validity and summarize the important results, and you are left to determine the relevance! Some of these sources include the Cochrane Library, Best Evidence, ACP Journal Club, Evidence-Based Practice, Evidence-Based Medicine, Journal of Family Practice POEMs, etc. Just for kicks, if you go to the ACP Journal Club Nov-Dec 1991 issue (revised November 1996), you will see their favorable review of this paper. You will also find other synopses of clinical trials of systolic hypertension in the elderly. If you search the Cochrane library, you will also find a meta-analysis of clinical trials of treating hypertension in the elderly that reaches the following conclusion:

"Randomized controlled trials establish that treating healthy older persons with hypertension is highly efficacious. Benefits of treatment with low dose diuretics or beta-blockers are clear for persons in their 60s to 70s with either diastolic or systolic hypertension. Differential treatment effects based on general risk factors, pre-existing cardiovascular disease and competing comorbidities could not be established from the published trial data."

When you are in clinical settings, go for the quick source when it is available!