Effect of Self-monitoring and Medication Self-titration on Systolic Blood Pressure in Hypertensive Patients at High Risk of Cardiovascular Disease

IMPORTANCE: Self-monitoring of blood pressure with self-titration of antihypertensives (self-management) results in lower blood pressure in patients with hypertension, but there are no data about patients in high-risk groups. OBJECTIVE: To determine the effect of self-monitoring with self-titration of antihypertensive medication compared with usual care on systolic blood pressure among patients with cardiovascular disease, diabetes, or chronic kidney disease. DESIGN, SETTING, AND PATIENTS: A primary care, unblinded, randomized clinical trial involving 552 patients who were aged at least 35 years with a history of stroke, coronary heart disease, diabetes, or chronic kidney disease and with baseline blood pressure of at least 130/80 mm Hg being treated at 59 UK primary care practices was conducted between March 2011 and January 2013. INTERVENTIONS: Self-monitoring of blood pressure combined with an individualized self-titration algorithm. During the study period, the office visit blood pressure measurement target was 130/80 mm Hg and the home measurement target was 120/75 mm Hg. Control patients received usual care consisting of seeing their health care clinician for routine blood pressure measurement and adjustment of medication if necessary. MAIN OUTCOMES AND MEASURES: The primary outcome was the difference in systolic blood pressure between intervention and control groups at the 12-month office visit. RESULTS: Primary outcome data were available from 450 patients (81%). The mean baseline blood pressure was 143.1/80.5 mm Hg in the intervention group and 143.6/79.5 mm Hg in the control group. After 12 months, the mean blood pressure had decreased to 128.2/73.8 mm Hg in the intervention group and to 137.8/76.3 mm Hg in the control group, a difference of 9.2 mm Hg (95% CI, 5.7-12.7) in systolic and 3.4 mm Hg (95% CI, 1.8-5.0) in diastolic blood pressure following correction for baseline blood pressure. Multiple imputation for missing values gave similar results: the mean baseline was 143.5/80.2 mm Hg in the intervention group vs 144.2/79.9 mm Hg in the control group, and at 12 months, the mean was 128.6/73.6 mm Hg in the intervention group vs 138.2/76.4 mm Hg in the control group, with a difference of 8.8 mm Hg (95% CI, 4.9-12.7) for systolic and 3.1 mm Hg (95% CI, 0.7-5.5) for diastolic blood pressure between groups. These results were comparable in all subgroups, without excessive adverse events. CONCLUSIONS AND RELEVANCE: Among patients with hypertension at high risk of cardiovascular disease, self-monitoring with self-titration of antihypertensive medication compared with usual care resulted in lower systolic blood pressure at 12 months

Effects of urea alone or with fungicide on the yield and breadmaking quality of wheat when sprayed at flag leaf and ear emergence

Urea (supplying 15 kg N/ha) applied to winter wheat (Triticum aestivum) at flag leaf emergence and again at ear emergence improved grain yield in only two, but increased grain nitrogen (N) in four out of five experiments. The size of the improvements in yield and nitrogen content differed over varying sites and seasons but were not affected by cultivar or propiconazole (250 g a.i./ha) plus tridemorph (500 g a.i./ha) fungicide applied with the urea. Breadmaking quality was assessed on grain from one site in 1985 and in 1986. The beneficial effects on loaf quality of urea and fungicide applied separately were reduced when they were applied as a mixture. In 1986 this negative interaction was associated with effects on sodium dodecyl sulphate (SDS) sedimentation volume, flour sulphur content (S), N/S ratio and dough resistance. The effect of urea also interacted with cultivar on SDS sedimentation volume in 1985 and dough resistance in 1986.Peer reviewe

The influence of late-season fungicide application and disease on the Hagberg falling number of grain from breadmaking varieties of winter wheat

Propiconazole plus tridemorph fungicide applied at flag leaf emergence and again at ear emergence reduced the Hagberg falling number (HFN) of whole grain flour from the winter wheat varieties, Avalon, Mission and Brimstone. The fungicide also controlled low powdery mildew (Erysiphe graminis f. sp. tritici) levels and severe Septoria tritici but results from plots sprayed either with or without fungicide showed no relationship between disease and HFN. Moisture content of the harvested grain was greater for plots sprayed with fungicide but this was not closely associated with lodging.Peer reviewe

Effects of spring nitrogen fertilizer on the Hagberg falling number of grain from breadmaking varieties of winter wheat

In a field experiment Hagberg falling number differed between varieties and was lowest for Brimstone and highest for Avalon. There was a linear increase in HFN with increasing nitrogen application for Avalon and Brimstone but Mission showed little response. Brimstone lodged more than Avalon or Mission, and nitrogen increased lodging. No sprouting of the grain was observed, however, and since increased lodging caused by nitrogen was not associated with decreased HFN, lodging was probably insufficiently severe for long enough to stimulate germination. This is supported by the moisture content readings at harvest which did not differ significantly between varieties or fertilizer applications. Nitrogen may have increased HFN in Avalon and Brimstone through delaying grain maturity. Further work is required, however, to confirm this and to explain why the HFN of Mission appeared little affected by nitrogen fertilizer application, which has also been found in other experiments.Peer reviewe

Dipodal Ferrocene-Based Adsorbate Molecules for Self-Assembled Monolayers on Gold

1,1′-Difunctionalised ferrocene derivatives have been studied, which contain groups suitable for chemisorption on gold substrates, namely [BOND]NC, [BOND]PR2 as well as a range of sulfur-containing units like [BOND]NCS, [BOND]SR, and thienyl. Thin films on gold have been fabricated from solution with most of these adsorbate species. Film thickness, composition and structure were investigated primarily by X-ray photoelectron and near-edge X-ray absorption fine-structure spectroscopy. The quality of self-assembled monolayers fabricated from 1,1′-diisocyanoferrocene (1) and 1,1′-diisothiocyanatoferrocene (2) turned out to be superior to that of films based on the other adsorbate species investigated. In addition to the surface coordination behaviour of 1 towards gold substrates, relevant aspects of the molecular coordination chemistry of 1 have also been addressed, including the synthesis and characterisation of [(μ-1){Cr(CO)5}2], [Ag2(μ-1)2](NO3)2⋅H2O and [(μ-1)(AuCl)2]. The crystal structure of the gold complex is governed by aurophilic interactions and can be taken as a model for the arrangement of 1 in self-assembled monolayers on gold