Efficacy of self-monitored blood pressure, with or without telemonitoring, for titration of antihypertensive medication (TASMINH4): an unmasked randomised controlled trial.

BACKGROUND: Studies evaluating titration of antihypertensive medication using self-monitoring give contradictory findings and the precise place of telemonitoring over self-monitoring alone is unclear. The TASMINH4 trial aimed to assess the efficacy of self-monitored blood pressure, with or without telemonitoring, for antihypertensive titration in primary care, compared with usual care. METHODS: This study was a parallel randomised controlled trial done in 142 general practices in the UK, and included hypertensive patients older than 35 years, with blood pressure higher than 140/90 mm Hg, who were willing to self-monitor their blood pressure. Patients were randomly assigned (1:1:1) to self-monitoring blood pressure (self-montoring group), to self-monitoring blood pressure with telemonitoring (telemonitoring group), or to usual care (clinic blood pressure; usual care group). Randomisation was by a secure web-based system. Neither participants nor investigators were masked to group assignment. The primary outcome was clinic measured systolic blood pressure at 12 months from randomisation. Primary analysis was of available cases. The trial is registered with ISRCTN, number ISRCTN 83571366. FINDINGS: 1182 participants were randomly assigned to the self-monitoring group (n=395), the telemonitoring group (n=393), or the usual care group (n=394), of whom 1003 (85%) were included in the primary analysis. After 12 months, systolic blood pressure was lower in both intervention groups compared with usual care (self-monitoring, 137·0 [SD 16·7] mm Hg and telemonitoring, 136·0 [16·1] mm Hg vs usual care, 140·4 [16·5]; adjusted mean differences vs usual care: self-monitoring alone, -3·5 mm Hg [95% CI -5·8 to -1·2]; telemonitoring, -4·7 mm Hg [-7·0 to -2·4]). No difference between the self-monitoring and telemonitoring groups was recorded (adjusted mean difference -1·2 mm Hg [95% CI -3·5 to 1·2]). Results were similar in sensitivity analyses including multiple imputation. Adverse events were similar between all three groups. INTERPRETATION: Self-monitoring, with or without telemonitoring, when used by general practitioners to titrate antihypertensive medication in individuals with poorly controlled blood pressure, leads to significantly lower blood pressure than titration guided by clinic readings. With most general practitioners and many patients using self-monitoring, it could become the cornerstone of hypertension management in primary care. FUNDING: National Institute for Health Research via Programme Grant for Applied Health Research (RP-PG-1209-10051), Professorship to RJM (NIHR-RP-R2-12-015), Oxford Collaboration for Leadership in Applied Health Research and Care, and Omron Healthcare UK

Synthesis of thiacrown and azacrown ethers based on a spiroacetal framework

A novel class of thiacrown and azacrown ethers incorporating the 1,7-dioxaspiro[5.5]undecane spiroacetal ring system was prepared by reaction of ditosylate 5 with the appropriate dithiols 9a–c or protected diamine 12a. Spiroacetal ditosylate 5 in turn, was prepared from diol 3 via ozonolysis of bisallyl ether 7 followed by tosylation of the derived diol 8

What causes differences of C-S-H gel grey levels in backscattered electron images?

Backscattered electron (BSE) images of heat-cured concretes show alite grains surrounded by inner C-S-H gel of two distinct grey levels (referred to as two-tone inner C-S-H gel). The lighter rim forms at elevated temperature whereas the darker rim develops during subsequent exposure to moisture at 20 °C. This microstructural feature can potentially be used as an indicator to assess the curing history of a concrete. However, microstructural examinations of room-temperature concretes containing silica fume or which have been exposed to severe conditions (external sulfate, carbonation) also show distinct rims of two-tone inner C-S-H gel. The chemical compositions of the rims were determined by EDX microanalysis in the scanning electron microscope (SEM). Our results show that for heat-cured samples, the different grey levels of the two-tone inner C-S-H are caused by relative differences in microporosity and water content and not by ones in chemical composition. However, in silica-fume blended concrete, sulfate attacked or carbonated specimens the different grey levels of the two-tone inner C-S-H gel were associated with significant differences in chemical composition. This difference allows two-tone inner C-S-H gel arising from heat curing to be distinguished from that arising from these other causes. © 2002 Elsevier Science Ltd. All rights reserved

Metal binding studies using spiroacetal thiacrown ethers

The binding ability of a series of spiroacetal thiacrown ethers with Li+, Na+, K+, Cs+, Co2+, Cd2+, Ag+ and Pb2+ is reported. The thiacrown ethers showed an affinity for the heavy metals. The interaction of the three thiacrown ethers 1–3 and [Al(acac)3] 5, [Co(NH3)5NO2](BPh4)2 6 and [Co(en)3](BPh4)3 7 complexes is also investigated