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Atrial fibrillation (AF) is the commonest heart rhythm abnormality, affecting around 8.8 million people in the European Union, and conferring a substantial risk of stroke and death. Up to 2% of the UK population, some 1.2 million individuals, take oral anticoagulation medication.
The University of Birmingham is an internationally-respected centre of excellence for research in AF, and has made crucial impacts in international clinical practice guidelines and improvements in patient care. Primary care research at the University of Birmingham has led to the transfer of oral anticoagulation services from secondary to primary care, and latterly patient self-management, resulting in improved clinical outcomes. In addition, the BAFTA trial has provided evidence to support the use of anticoagulation therapy (warfarin) for people aged over 75 who have atrial fibrillation, resulting in changes in clinical management of these patients.
Clinical research at RVC commencing in 1994 has changed clinical practice in management of feline chronic kidney disease (CKD) by transforming international consensus on diagnostic and treatment guidelines on proteinuria, hypertension and hyperphosphataemia. The research has informed the development of new products to manage hyperphosphataemia and diagnostics for identification of low level proteinuria in cats, deemed unimportant prior to publication of the RVC's research. RVC academics have worked in partnership with industry and used research results to change clinical practice guidelines through participation in consensus expert groups and increasing acceptance of new guidelines by outreach activities to general practitioners in UK, Europe, Asia and the USA in the form of publication of textbook chapters, lectures at major conferences and e- learning platforms to explain the underpinning research-based evidence.
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.
Research by Professor Elliott and colleagues at Imperial College on worldwide salt and potassium intakes, their relationships to blood pressure, and co-authored systematic reviews and meta-analyses of their effects in adults and children on blood pressure and cardiovascular disease — and potential adverse effects — has played an instrumental role in developing international guidelines and public policy on sodium reduction strategies. Furthermore, published primary research has influenced US Centers for Disease Control and Prevention (CDC) strategies for population-wide monitoring of sodium intakes in the USA. This work has thus had impact on policies for sodium reduction and monitoring of sodium intakes worldwide.
Novel work undertaken at this centre has demonstrated that vitamin B2 (riboflavin) can significantly decrease BP, specifically in people with a common genetic variant affecting the folate-metabolising enzyme MTHFR. The extent of BP-lowering demonstrated is as good as that expected from BP-lowering drugs and much better than that found with common dietary approaches and furthermore, the effect is independent of concurrent BP-lowering drugs. These findings offer a simple, cost-effective targeted treatment for the management of BP in this genetically at-risk group. The global prevalence of this genetic variant is 10% but can be as high as 32% in other countries such as Mexico and Northern China.
Before the Hypertension in the Very Elderly Trial (HYVET) it was not clear whether people aged 80 and over with hypertension should receive antihypertensive treatment. The over 80s are one of the fastest growing groups in society and are at high risk of hypertension and its sequelae due to age. HYVET demonstrated benefit of treatment including reduced mortality and cardiovascular comorbidity. Guidelines around the world for the treatment of hypertension have changed as a result. In the UK it is proposed that the Quality Outcomes Framework (QOF) for GPs now includes those over 80 and uses the target blood pressure used in HYVET.
Many research groups around the world have produced evidence that cardiovascular disease (CVD) can be prevented by dietary salt reduction. The specific contribution of the University of Warwick consists of primary research carried out between 2005 and 2013 by Professor Francesco Cappuccio, who has demonstrated that lower salt intake can lead to a reduction in strokes and total cardiovascular events. These results have informed public health awareness and policy- making both nationally and globally. The research contributed directly to the development of a national policy for salt reduction by the UK National Institute for Health and Care Excellence (NICE) in 2010 by indicating the likely health gains of a population strategy. The research also influenced global policies set out by the World Health Organization (WHO) in 2007, 2010 and 2012. Population-wide reductions in dietary salt are now the second priority after tobacco control set by the United Nations in 2011 for the prevention of non-communicable disease worldwide.
Hypertension is well known to increase the risk of stroke and other cardiovascular diseases, but up until recently few very elderly people received treatment for it. The first large randomised trial of the pharmacological treatment of hypertension in people aged 80 and over — the Hypertension in the Very Elderly Trial (HYVET) — demonstrated clear benefits of such treatment for this age group. As a direct result of HYVET, changes were made to a number of influential national and international guidelines on the treatment of hypertension, including those published by the UK's National Institute for Health and Clinical Excellence (NICE).
MacGregor and colleagues working at St George's have provided extensive clinical and epidemiological evidence that has changed UK government policy on recommendations for salt intake. In 2011 NICE recommended continued reduction in dietary salt intake in the UK. A 3 gm reduction in daily salt intake is calculated to result in 14-20,000 fewer deaths from cardiovascular disease annually, a saving of approximately £350 million in healthcare costs, and the gain of 130,000 quality-adjusted life years. The global benefits of this policy have been recognised with the WHO making recommendations for similar levels of salt reduction worldwide.
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.