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Research led by Professor Brown has led to widespread changes in clinical practice regarding the management of Hypertension. Following his demonstration that patients' response to drugs for Hypertension is variable (in a systematic manner), subsequent clinical guidelines acknowledged the variability among patients, and changed from recommending the same treatment for all patients, to an algorithm based on the Cambridge AB/CD rule. The simplicity of the AB/CD rule led to popularity among doctors, and adoption by national bodies — British Hypertension Society, NICE, and foreign guidelines, and by textbooks of Medicine. The guidelines arising from his research have contributed to improved health outcomes in the UK. Specifically, NICE's simple and rational guidance how to reach strict targets for blood pressure is credited with changing the UK from the poorest to best performing country in Europe.
The Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT; Co-Chairman, Professor Sever) was an investigator designed and led multinational study in which different blood pressure-lowering and lipid-lowering treatment strategies were investigated in an attempt to define optimal programmes for intervention to prevent cardiovascular disease in hypertensive subjects. The outcomes of both the antihypertensive arm and the lipid arm of the trial defined the benefits of more contemporary treatments for hypertensive subjects, including calcium channel blockers, angiotensin converting enzyme inhibitors and statins, which have been incorporated into national and international guidelines (including NICE), and have impacted on current clinical practice in the prevention of cardiovascular disease worldwide.
This case study outlines the impact of novel omega-3 fatty acid therapy for sickle cell disease on health and policy. 128 patients on the treatment since 2010, and another 300 who started to receive it in June 2012 have seen remarkable improvements in health and quality of life as assessed by reductions in hospital admission and absence from work/school due to the disease. A panel of experts set up by the Ministry of Health of Sudan to evaluate the evidence recommended the integration of the therapy in the management of the disease in a policy report dated December 20, 2012. The Ministry has accepted the recommendation.
In response to the gap between standards and the reality of preventive cardiovascular disease (CVD) health care delivered across Europe, Imperial College researchers developed an innovative nurse-led, multidisciplinary, family centred, CVD prevention programme (EUROACTION) and led its evaluation in hospital and general practice across 8 European countries. We showed that patients and their families in our programme can achieve healthier lifestyles and better risk factor management compared to usual care and these differences were sustained out to one year. We then adapted our learning from EUROACTION for the NHS, by integrating secondary and primary prevention into one community service (MYACTION), and managing cardiovascular disease as a family of diseases with common antecedents. To train doctors, nurses and allied professionals to deliver MYACTION we created an MSc in Preventive Cardiology which is now in its 6th year. EUROACTION is now recommended as an evidence based model of care in current European CVD prevention guidelines, and MYACTION is being commissioned by the NHS in London, and Galway, Republic of Ireland, and by the Western Isles Health Board. Our research has impacted directly on the development and delivery of high quality preventive care in both Europe, and the NHS, and on the training of doctors, nurses and allied health professionals in preventive cardiology.
Pulmonary arterial hypertension (PAH) is a fatal disease that typically affects women in their childbearing years. Professor Wilkins led a research team at Imperial College that identified phosphodiesterase type 5 (PDE5) as a drug target in the lungs of patients with PAH. Imperial validated the target in cell and animal models and demonstrated proof in patients that Sildenafil, a PDE5 inhibitor, was an effective treatment for PAH. Professor Wilkins conducted a clinical study to compare the effect of oral Sildenafil with Bosentan, the only other available oral therapy for PAH at the time. This study was the first, and remains the only, head-to-head study of two treatments for PAH. Sildenafil demonstrated comparable efficacy, had a greater effect on reducing cardiac mass (an integrated measure of heart work) and was well tolerated.
Sildenafil is now the most commonly prescribed drug for PAH. It is the most cost-effective, as judged by a technology appraisal initiated by NICE. National and international guidelines recommend Sildenafil as a first line treatment for patients in functional classes II and III pulmonary hypertension. Worldwide sales of sildenafil (Revatio®) for the management of PAH were $500m in 2010. With the expiration of the patent the cost of treatment will fall further.
Around 25% of UK adults have high blood pressure (hypertension), accounting for more than half of all strokes and heart disease. The pressure that the heart and brain senses that leads to these diseases is central aortic pressure. The Unit's research developed and evaluated methods for the non-invasive assessment of central aortic pressure, demonstrating its important relationship to clinical outcomes. The work has contributed to improvements in the way high blood pressure is treated for millions of people, nationally and worldwide, by (i) providing a rationale for one of the biggest-ever changes in treatment guidance in 2006; (ii) stimulating major growth in medical devices for the non-invasive measurement of aortic pressure with a simple, easy-to-use wristwatch invention; (iii) and developing central aortic pressure as a better biomarker for pharmaceutical companies to develop new drugs to treat hypertension.
Caulfield co-led and was a principal investigator (PI) on Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT). Hitman co-led and was a PI on Collaborative AtoRvastatin Diabetes Study (CARDS). These studies dramatically changed national and international guidance for diabetes, hypertension and cholesterol, leading to widespread and far-reaching changes in management of common and potentially fatal risk factors. For example, the proportion of hypertensive patients in England with good BP control (<140/90) rose from 52% in 2006 to 62% in 2011; the mean total cholesterol level of the population has fallen by 0.5 Mmol/L between 1998 and 2011.
Research in Leeds has identified independent risk factors associated with pressure ulcer development and made a significant contribution to the evidence base for choosing the most cost- effective mattress to prevent pressure ulcers. Through publication and subsequent integration into systematic reviews/ practice guidelines, and membership of committees the research has been disseminated to policy makers and practitioners. Leeds evidence is now included in international guidelines in at least 17 languages. This has led to a change in clinical and purchasing practice with likely reduction in the number of pressure ulcers and health service cost.
Impact: Health and wellbeing; translation of a clear evidence base for reducing red blood cell use in intensive care and surgery into guidelines and changed clinical practice.
Significance: A 20% reduction in overall UK red blood cell usage between 2002-2012, saving the NHS approximately £100M annually; 7000 fewer patients are exposed to red cell transfusion annually, saving 500 lives.
Beneficiaries: Patients in intensive care units; the NHS and healthcare delivery agencies.
Attribution: Studies were led by Walsh at UoE with NHS and Canadian collaborators.
Reach: 7000 patients per year, UK-wide; incorporation into international guidelines.
High blood pressure (or hypertension) is the major cause of stroke and other cardiovascular disease, and is one of the most important preventable causes of morbidity and mortality in developed and developing countries. In the UK it affects half the population over 60 and costs the NHS £1Bn per year in drugs alone.
A University of Birmingham primary care-led study has provided definitive evidence of the superiority of ambulatory blood pressure measurement (ABPM) over clinic and home blood pressure monitoring as a means of diagnosing hypertension. The associated cost-effectiveness study showed that this approach will save the NHS over £10.5M per year. As a result of this research, NICE guidelines have been amended and ABPM has become the reference standard. The research has also influenced public and policy debate in the UK and internationally.