5 research outputs found

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

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    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

    Effectiveness of actions intended to achieve a voluntary transition from the use of lead to non-lead shotgun ammunition for hunting in Britain

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    In 2020, nine major UK shooting and rural organisations proposed a voluntary transition from the use for hunting of lead shotgun ammunition to non-lead alternatives. The major food retailer Waitrose & Partners has announced its intention to move to not supplying game meat products from animals killed using any kind of lead ammunition and the National Game Dealers Association announced a plan for a similar policy to be implemented in 2022. The SHOT-SWITCH research project, which is intended to monitor the progress of these voluntary initiatives, began in the 2020/2021 shooting season. The project monitors changes in the proportions of wild-shot common pheasants Phasianus colchicus available to consumers in Great Britain that had been killed using lead and non-lead shotgun ammunition, as assessed by using inductively coupled plasma atomic emission spectrometry to identify the composition of shotgun pellets recovered from carcasses. In 2020/2021, 99.4% of the pheasants sampled had been killed using lead ammunition. We report here further results from this study for the 2021/2022 season. We found that 99.5% of the 215 pheasants from which shotgun pellets were recovered had been killed using lead ammunition. We conclude that the shooting and rural organisations’ joint statement and two years of their considerable efforts in education, awareness-raising and promotion, have not yet had a detectable effect on the ammunition types used by hunters who supply pheasants to the British game meat market
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