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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.
A novel pressure-relieving technology has been developed to enhance the quality of life of a range of people. This has enabled the development firstly of a novel compression therapy system for the prevention and treatment of venous leg ulcers especially for middle-aged and older communities as well as having the potential for huge savings to the NHS. Secondly, is a unique pressure-relieving cushion to reduce pressure sores with specific applications for wheelchair users. Baltex Ltd, UK are successfully producing both commercially. An exclusive agreement has been signed with a global medical device company, BSN Medical for marketing the single-layer bandage.
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.
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.
Impact: Health and welfare; the GRACE risk score (derived using data from 102,000 patients with acute coronary syndrome (ACS) in 30 countries) identifies high-risk ACS patients more effectively than do alternative methods.
Significance: GRACE is now a reference standard and has resulted in international guideline changes. It is estimated to save 30-80 lives for every 10,000 patients presenting with non-ST elevation ACS.
Beneficiaries: Patients with ACS; the NHS and healthcare delivery organisations.
Attribution: All work was led by Fox (UoE) with co-chair Gore (University of Massachusetts) and was developed from Edinburgh-based studies.
Reach: Worldwide: guidelines adopted in more than 55 countries; >10,000 downloads of app.
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.
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.
Over the past ten years, the prescription of cholesterol-lowering statins has soared and they are now the most prescribed drugs in the UK and the US. However, this has raised concerns about inappropriate prescribing. University of Glasgow research has been pivotal in addressing this issue and has triggered revision of major international guidelines to stratify patients in the general population for statin therapy and guide statin use in the rheumatoid arthritis patient population. The identification of a statin-associated risk for diabetes prompted the European Medicines Agency and the US Food & Drug Administration to revise safety labelling for all classes of statins. This risk is now communicated to the 27 million patients in the UK and US who are prescribed statins.
Venous Thromboembolism (VTE) is a disease which comprises of Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE). In 2005, VTE typically caused 25,000 - 32,000 deaths a year, at a typical annual cost to the National Health Service of £640 million (House of Commons Health Select Committee, 2005). However, this disease is mostly preventable (NICE, 2007).
The Autar DVT risk assessment scale was developed to enable clinicians to stratify patients by their risk of developing DVT. The scale exceeded expectations, leading to the introduction of the first mandatory VTE risk assessment tool nationally and shifting the focus of VTE management from reactive treatment (which is resource exhaustive) to very cost effective, proactive, prevention.
The scale continues to be used (both nationally and internationally), and to have impacts that are both financial (cost savings for hospitals) and relate to the wellbeing of patients, both through improved quality of life and reduced morbidity.
QRISK is a new algorithm which predicts an individual's risk of cardiovascular over 10 years. It was developed using the QResearch database and is in routine use across the NHS. It is included in national guidelines from NICE and the Department of Health and in the GP quality and outcomes framework. It is incorporated into > 90% of GP computer systems as well as pharmacy and secondary care systems. The web calculator has been used >500,000 times worldwide. ClinRisk Ltd was incorporated in 2008 to develop software to ensure the reliable widespread implementation of the QRISK algorithm into clinical practice.