18 research outputs found
Non-adherence to antihypertensive medication is very common among resistant hypertensives: results of a directly observed therapy clinic.
Resistant hypertension is common among the hypertensive population with reported prevalence of 12 to 15%. These patients have a higher cardiovascular risk and consequently a poorer cardiovascular prognosis. Suboptimal adherence with antihypertensive medication is a common contributing factor in apparent treatment-resistant hypertension. Patients were observed taking their medications under direct supervision at our directly observed therapy (DOT) clinic. At the DOT clinic visit, patients were fitted with a 24-h ambulatory blood pressure (ABP) monitor and each drug, at currently prescribed dose, was administered by a nurse; at an hourly interval and patient observed for 7 h. ABP readings between pre and post DOT clinic were compared. Fifty out of 56 patients had complete data on the ABP. Twenty four were female and the mean (s.d.) age was 62.0 (11.0) years. On the basis of the study methods that differentiated patients according to their BP response during the DOT clinic, twenty-five (50.0%) patients were deemed to be truly resistant (24-h ambulatory systolic blood pressure (SBP) fall <5 mm Hg) and the remaining 25 were deemed to have clinically significant non-adherence (24-h ambulatory SBP fall ⩾5 mm Hg) to prescribed therapy. In non-adherent patients, the mean 24-h ambulatory BP drop observed was 19.5/9.4 mm Hg (P<0.001 for both). Our results suggest that non-adherence is very common among patients considered to have apparent treatment-resistant hypertension. DOT clinic can be an effective method of identifying the truly resistant hypertensive patients.Journal of Human Hypertension advance online publication, 7 May 2015; doi:10.1038/jhh.2015.38
Multiplanar Sinus CT: A Systematic Approach to Imaging Before Functional Endoscopic Sinus Surgery
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'Raising the pulse': the environmental, nutritional and health benefits of pulse-enhanced foods
Diet is a key modulator of non-communicable diseases, and food production represents a major cause of environmental degradation and greenhouse gas emissions. Yet ‘nudging’ people to make better food choices is challenging, as factors including affordability, convenience and taste often take priority over achievement of health and environmental benefits. The overall ‘Raising the Pulse’ project aim is to bring about a step change in the nutritional value of the UK consumers’ diet, and to do so in a way which leads to improved health and greater sustainability within the UK food system.
To achieve our objectives, UK-specific faba bean production systems that optimise both end users’ diets and environmental and economic sustainability of production will be implemented in collaboration with key stakeholders (including industry, the retail sector and government). Palatable faba bean flours will be produced and used to develop ‘Raising the Pulse’ food products with improved nutritional profile and environmental value. Consumer focus groups and workshops will establish attitudes, preferences, drivers of, and barriers to increased consumption of such products. They will inform the co-creation of sensory testing and University-wide intervention studies to evaluate the effects of pulses and ‘Raising the Pulse’ foods on diet quality, self-reported satiety, nutritional knowledge, consumer acceptance and market potential. Nutrient bioavailability and satiety will be evaluated in a randomised controlled postprandial human study. Finally, a system model will be developed that predicts changes to land use, environment, business viability, nutrition, and human health after substitution of existing less nutritionally beneficial and environmentally sustainable ingredients with pulses.
Government health and sustainability priorities will be addressed, helping to define policy-relevant solutions with significant beneficial supply chain economic impacts, and transformed sustainable food systems to improve consumer diet quality, health and the environment