Maximizing the benefit of treatment in mild hypertension:three simple steps to improve diagnostic accuracy.

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldBACKGROUND: Most patients only have three measurements of blood pressure before being labelled as hypertensive. This may lead to inaccurate classification, unnecessary treatment and dilution in treatment benefit for the population. Aim: To examine the accuracy of current methods of diagnosing mild hypertension, and to explore ways to improving targeting of antihypertensive treatment without entailing lengthy observation. DESIGN: Re-analysis of published data. METHODS: We tested current diagnostic methods using the data for 3965 individuals who were followed for a year in the placebo arm of the MRC Mild Hypertension Trial. We calculated the proportion selected for treatment by current methods and the diagnostic accuracy, using average blood pressure beyond 6 months as representing 'true' long-term blood pressure. We examined the benefit of averaging blood pressures, of prolonging observation modestly and of estimating within-person blood pressure variability. RESULTS: Prolonging observation to 3 months selects a smaller (by about 12%) proportion of the sample for treatment, a proportion similar to that defined as 'truly' hypertensive. The diagnostic accuracy of current methods is poor, with up to 69% discrepancy in classification. This discrepancy was improved by up to 18% in absolute terms by prolonging observation to 3 months and using average blood pressures. Identifying those individuals with low within-person variability allows marked improvement in the prediction of 'true' hypertension. DISCUSSION: Although some inaccuracy in the diagnosis of hypertension is inevitable, observation for 3 months, averaging blood pressures and estimating within-person blood pressure variability can markedly improve upon current practice

Current Therapeutic Advances Targeting EGFR and EGFRvIII in Glioblastoma

EGFR and EGFRvIII analysis is of current interest in glioblastoma- the most common malignant primary CNS tumour, because of new EGFRvIII vaccine trials underway. EGFR activation in glioblastoma promotes cellular proliferation via activation of MAPK and PI3K-Akt pathways and EGFRvIII is the most common variant, leading to constitutively active EGFR. This review explains EGFR and EGFRvIII signalling in GBM; describes targeted therapy approaches to date including tyrosine kinase inhibitor, antibody-based therapies, vaccines and preclinical RNA-based therapies and discusses the difficulties encountered with these approaches including pathway redundancy and intratumoural heterogeneity

The case for home monitoring in hypertension

Although the assessment of cardiovascular risk in individual patients takes into account a range of risk factors, the diagnosis and management of hypertension (high blood pressure) is largely determined by a single numerical value, albeit that often several readings are taken over time. Given the critical impact of a decision to embark on lifelong drug therapy, the importance of ensuring that a blood pressure (BP) record is both accurate and representative is clear. However, there is good evidence that the variability of BP is such that even if measurement is of the highest quality, it can be difficult to say with confidence whether a patient is above or below a treatment threshold. This commentary argues that current BP measurement is inadequate to make the clinical decisions that are necessary and that multiple readings are required to deliver an acceptable degree of accuracy for safe decision-making. This is impractical in a doctor's surgery, and the only realistic long-term strategy is to involve the patient in measuring his or her own BP in their own environment. Evidence is presented that such a strategy is better able to predict risk, is cost-effective for diagnosing hypertension, can improve BP control and is thus better able to protect individuals in the future

Prediction and Simulator Verification of Roll/Lateral Adverse Aeroservoelastic Rotorcraft–Pilot Couplings

The involuntary interaction of a pilot with an aircraft can be described as pilot-assisted oscillations. Such phenomena are usually only addressed late in the design process when they manifest themselves during ground/flight testing. Methods to be able to predict such phenomena as early as possible are therefore useful. This work describes a technique to predict the adverse aeroservoelastic rotorcraft–pilot couplings, specifically between a rotorcraft’s roll motion and the resultant involuntary pilot lateral cyclic motion. By coupling linear vehicle aeroservoelastic models and experimentally identified pilot biodynamic models, pilot-assisted oscillations and no-pilot-assisted oscillation conditions have been numerically predicted for a soft-in-plane hingeless helicopter with a lightly damped regressive lead–lag mode that strongly interacts with the roll modeat a frequency within the biodynamic band of the pilots. These predictions have then been verified using real-time flight-simulation experiments. The absence of any similar adverse couplings experienced while using only rigid-body models in the flight simulator verified that the observed phenomena were indeed aeroelastic in nature. The excellent agreement between the numerical predictions and the observed experimental results indicates that the techniques developed in this paper can be used to highlight the proneness of new or existing designs to pilot-assisted oscillation