Home and Online Management and Evaluation of Blood Pressure (HOME BP) using a digital intervention in poorly controlled hypertension: randomised controlled trial

Objective: The HOME BP (Home and Online Management and Evaluation of Blood Pressure) trial aimed to test a digital intervention for hypertension management in primary care by combining self-monitoring of blood pressure with guided self-management. Design: Unmasked randomised controlled trial with automated ascertainment of primary endpoint. Setting: 76 general practices in the United Kingdom. Participants: 622 people with treated but poorly controlled hypertension (>140/90 mm Hg) and access to the internet. Interventions: Participants were randomised by using a minimisation algorithm to self-monitoring of blood pressure with a digital intervention (305 participants) or usual care (routine hypertension care, with appointments and drug changes made at the discretion of the general practitioner; 317 participants). The digital intervention provided feedback of blood pressure results to patients and professionals with optional lifestyle advice and motivational support. Target blood pressure for hypertension, diabetes, and people aged 80 or older followed UK national guidelines. Main outcome measures: The primary outcome was the difference in systolic blood pressure (mean of second and third readings) after one year, adjusted for baseline blood pressure, blood pressure target, age, and practice, with multiple imputation for missing values. Results: After one year, data were available from 552 participants (88.6%) with imputation for the remaining 70 participants (11.4%). Mean blood pressure dropped from 151.7/86.4 to 138.4/80.2 mm Hg in the intervention group and from 151.6/85.3 to 141.8/79.8 mm Hg in the usual care group, giving a mean difference in systolic blood pressure of −3.4 mm Hg (95% confidence interval −6.1 to −0.8 mm Hg) and a mean difference in diastolic blood pressure of −0.5 mm Hg (−1.9 to 0.9 mm Hg). Results were comparable in the complete case analysis and adverse effects were similar between groups. Within trial costs showed an incremental cost effectiveness ratio of £11 ($15, €12; 95% confidence interval £6 to £29) per mm Hg reduction. Conclusions: The HOME BP digital intervention for the management of hypertension by using self-monitored blood pressure led to better control of systolic blood pressure after one year than usual care, with low incremental costs. Implementation in primary care will require integration into clinical workflows and consideration of people who are digitally excluded. Trial registration: ISRCTN13790648

Mean global ocean temperatures during the last glacial transition

Little is known about the ocean temperature’s long-term response to climate perturbations owing to limited observations and a lack of robust reconstructions. Although most of the anthropogenic heat added to the climate system has been taken up by the ocean up until now, its role in a century and beyond is uncertain. Here, using noble gases trapped in ice cores, we show that the mean global ocean temperature increased by 2.57 ± 0.24 degrees Celsius over the last glacial transition (20,000 to 10,000 years ago). Our reconstruction provides unprecedented precision and temporal resolution for the integrated global ocean, in contrast to the depth-, region-, organism- and season-specific estimates provided by other methods. We find that the mean global ocean temperature is closely correlated with Antarctic temperature and has no lead or lag with atmospheric CO₂, thereby confirming the important role of Southern Hemisphere climate in global climate trends. We also reveal an enigmatic 700-year warming during the early Younger Dryas period (about 12,000 years ago) that surpasses estimates of modern ocean heat uptake

Contrasted hydrothermal activity along the South-East Indian Ridge (130°E-140°E): From crustal to ultramafic circulation

International audienceUsing a combined approach of seafloor mapping, MAPR and CTD survey, we report evidence for active hydrothermal venting along the 1308-1408E section of the poorly-known SouthEast Indian Ridge (SEIR) from the Australia-Antarctic Discordance (AAD) to the George V Fracture Zone (FZ). Along the latter, we report Eh and CH 4 anomalies in the water column above a serpentinite massif, which unambiguously testify for ultramafic-related fluid flow. This is the first time that such circulation is observed on an intermediate-spreading ridge. The ridge axis itself is characterized by numerous off-axis volcanoes, suggesting a high magma supply. The water column survey indicates the presence of at least ten distinct hydrothermal plumes along the axis. The CH 4 :Mn ratios of the plumes vary from 0.37 to 0.65 denoting different underlying processes, from typical basalt-hosted to ultramafic-hosted high-temperature hydrothermal circulation. Our data suggest that the change of mantle temperature along the SEIR not only regulates the magma supply, but also the hydrothermal activity. The distribution of hydrothermal plumes from a ridge segment to another implies secondary controls such as the presence of fractures and faults along the axis or in the axial discontinuities. We conclude from these results that hydrothermal activity along the SEIR is controlled by magmatic processes at the regional scale and by the tectonics at the segment scale, which influences the type of hydrothermal circulation and leads to various chemical compositions. Such variety may impact global biogeochemical cycles, especially in the Southern Ocean where hydrothermal venting might be the only source of nutrients