Brit J Hosp Med
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Associations of hypertension with ischaemic stroke and intracerebral haemorrhage, particularly when attributed to cerebral small vessel disease, are well established. While it seems plausible that treating hypertension should prevent small vessel disease from developing or progressing, there is limited evidence demonstrating this. This article critically appraises the evidence answering this clinical question. ⋯ Therefore, the article also summarises data on prevention of progression of chronic kidney disease. Evidence supports a target blood pressure of <130/80 mmHg to optimally prevent progression of both small vessel disease and chronic kidney disease. However, future studies are needed to determine long-term effects of more intensive blood pressure treatment targets on small vessel disease progression and incident dementia.
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Medical errors resulting in treatment-related harm have been a challenge for many years, with particularly severe consequences in surgery. Efforts to improve safety should focus on system-based changes to response and rescue pathways, and will require further research and adequate engagement by clinical staff.