Publications
417 results found
W Tobe S, Global Alliance for Chronic Diseases Hypertension Research Teams With the World Hypertension League, 2016, The Global Alliance for Chronic Diseases Supports 15 Major Studies in Hypertension Prevention and Control in Low- and Middle-Income Countries., J Clin Hypertens (Greenwich), Vol: 18, Pages: 600-605
Selak V, Bullen C, Stepien S, et al., 2016, Do polypills lead to neglect of lifestyle risk factors? Findings from an individual participant data meta-analysis among 3140 patients at high risk of cardiovascular disease, European Journal of Preventive Cardiology, Vol: 23, Pages: 1393-1400, ISSN: 2047-4881
AIM: The aim of this study was to investigate whether polypill-based care for the prevention of cardiovascular disease (CVD) is associated with a change in lifestyle risk factors when compared with usual care, among patients with CVD or high calculated cardiovascular risk. METHODS: We conducted an individual participant data meta-analysis of three trials including patients from Australia, England, India, Ireland, the Netherlands and New Zealand that compared a strategy using a polypill containing aspirin, statin and antihypertensive therapy with usual care in patients with a prior CVD event or who were at high risk of their first event. Analyses investigated any differential effect on anthropometric measures and self-reported lifestyle behaviours. RESULTS: Among 3140 patients (75% male, mean age 62 years and 76% with a prior CVD event) there was no difference in lifestyle risk factors in those randomised to polypill-based care compared with usual care over a median of 15 months, either across all participants combined, or in a range of subgroups. Furthermore, narrow confidence intervals (CIs) excluded any major effect; for example differences between the groups in body mass index was -0.1 (95% CI -0.2 to 0.1) kg/m(2), in weekly duration of moderate intensity physical activity was -2 (-26 to 23) minutes and the proportion of smokers was 16% vs 17% (RR 0.98, 0.84 to 1.15) at the end of trial. DISCUSSION: This analysis allays concern that polypill-based care may lead to neglect of lifestyle risk factors, at least among high-risk patients. Maximally effective preventive approaches should address lifestyle factors alongside pharmaceutical interventions, as recommended by major international guidelines.
Poulter NR, Anjum A, Cross M, et al., 2016, [OP.LB01.07] A COMPARISON OF THE IMPACT OF MORNING OR NIGHT DELIVERY OF ANTIHYPERTENSIVE AGENTS ON 24 HOUR AMBULATORY BLOOD PRESSURE MONITORING (ABPM) LEVELS: A RANDOMISED CROSS-OVER TRIAL., Pages: e37-e38
Poulter N, Anjum A, Cross M, et al., 2016, A comparison of the impact of morning or night delivery of antihypertensive agents on 24 hour ambulatory blood pressure monitoring (ABPM) levels: a randomised cross-over trial, Pages: 641-641
Poulter N, Anjum A, Cross M, et al., 2016, LBOS 01-01A COMPARISON OF THE IMPACT OF MORNING OR NIGHT DELIVERY OF ANTIHYPERTENSIVE AGENTS ON 24 HOUR ABPM LEVELS: A RANDOMISED CROSS-OVER TRIAL (HARMONY).
Webster R, Patel A, Selak V, et al., 2015, Effectiveness of fixed dose combination medication ('polypills') compared with usual care in patients with cardiovascular disease or at high risk: A prospective, individual patient data meta-analysis of 3140 patients in six countries, International Journal of Cardiology, Vol: 205, Pages: 147-156, ISSN: 1874-1754
AimsTo conduct a prospective, individual participant data (IPD) meta-analysis of randomised controlled trials comparing a polypill-based approach with usual care in high risk individuals.Methods and resultsThree trials comparing polypill-based care with usual care in individuals with CVD or high calculated cardiovascular risk contributed IPD. Primary outcomes were self-reported adherence to combination therapy (anti-platelet, statin and ≥ two blood pressure (BP) lowering agents), and difference in mean systolic BP (SBP) and LDL-cholesterol at 12 months. Analyses used random effects models. Among 3140 patients from Australia, England, India, Ireland, New Zealand and The Netherlands (75% male, mean age 62 years), median follow-up was 15 months. At baseline, 84%, 87% and 61% respectively were taking a statin, anti-platelet agent and at least two BP lowering agents. At 12 months, compared to usual care, participants in the polypill arm had higher adherence to combination therapy (80% vs. 50%, RR 1.58; 95% CI, 1.32 to 1.90; p < 0.001), lower SBP (− 2.5 mmHg; 95% CI, − 4.5 to − 0.4; p = 0.02) and lower LDL-cholesterol (− 0.1 mmol/L; 95% CI, − 0.2 to 0.0; p = 0.04). Baseline treatment levels were a major effect modifier for adherence and SBP (p-homog < 0.0001 and 0.02 respectively) with greatest improvements seen among those under-treated at baseline.ConclusionsPolypill therapy significantly improved adherence, SBP and LDL-cholesterol in high risk patients compared with usual care, especially among those who were under-treated at baseline.
Thom SAM, Ward H, Wood F, et al., 2015, Process evaluation of the impact and acceptability of a polypill for prevention of cardiovascular disease, BMJ Open, Vol: 9, ISSN: 2044-6055
Importance The Use of a Multidrug Pill In Reducing cardiovascular Events (UMPIRE) trial has shown improved adherence with the use of a polypill strategy when compared with usual medications for cardiovascular disease (CVD) prevention. To advance from efficacy to impact, we need a better understanding of why and how such a strategy might be deployed in complex health systems.Objective To understand, from the perspective of UMPIRE trial participants and professionals, how and why a polypill strategy improves adherence compared with usual care, why improvement is greater in some subgroups, and to explore the acceptability of a polypill strategy among trial participants and healthcare professionals.Design, setting and participants A preplanned process evaluation, based on qualitative interviews, was conducted with a subsample of 102 trial participants and 41 healthcare professionals at the end of the UMPIRE trial in India and Europe.Results Most patients contrasted the simplicity of the polypill with usual medications that they found complex and, for many in India, expensive. Patients with low baseline adherence struggled most with complex medication lists, and those without established disease described less motivation to adhere when compared with people who had already been diagnosed with CVD; people in the latter group had already undertaken self-directed measures to adhere to CVD preventive medicines prior to entering the trial. Taking medication was one of many adaptations described by patients; these included dietary changes, stopping smoking and maintaining exercise. Most patients liked the polypill strategy, although some participants and health professionals were concerned that it would provide less tailored therapy for individual needs.Conclusions Adherence to treatment lists with multiple medications is complex and influenced by several factors. Simplifying medication by using a once-daily polypill is one approach to CVD prevention that may enhance adherence.
Thompson DM, Hughes A, Stanton A, et al., 2015, Long-term anti-hypertensive treatment with amlodipine/perindopril results in lower carotid IMT at 3.5 years than with atenolol/bendroflumethiazide, Congress of the European-Society-of-Cardiology (ESC), Publisher: OXFORD UNIV PRESS, Pages: 1142-1143, ISSN: 0195-668X
Brown CE, McCarthy NS, Hughes AD, et al., 2015, Urinary proteomic biomarkers to predict cardiovascular events, Proteomics Clinical Applications, Vol: 9, Pages: 610-617, ISSN: 1862-8354
PurposeWe have previously demonstrated associations between the urinary proteome profile and coronary artery disease (CAD) in cross-sectional studies. Here, we evaluate the potential of a urinary proteomic panel as a predictor of CAD in the hypertensive atherosclerotic cardiovascular disease (HACVD) substudy population of the Anglo-Scandinavian Cardiac Outcomes Trial study.Experimental designThirty-seven cases with primary CAD endpoint were matched for sex and age to controls who had not reached a CAD endpoint during the study. Spot urine samples were analyzed using CE coupled to Micro-TOF MS. A previously developed 238-marker CE-MS model for diagnosis of CAD (CAD238) was assessed for its predictive potential.ResultsSixty urine samples (32 cases; 28 controls; 88% male, mean age 64 ± 5 years) were analyzed. There was a trend toward healthier values in controls for the CAD model classifier (–0.432 ± 0.326 versus –0.587 ± 0.297, p = 0.170), and the CAD model showed statistical significance on Kaplan–Meier survival analysis p = 0.021. We found 190 individual markers out of 1501 urinary peptides that separated cases and controls (AUC >0.6). Of these, 25 peptides were also components of CAD238.Conclusion and clinical relevanceA urinary proteome panel originally developed in a cross-sectional study predicts CAD endpoints independent of age and sex in a well-controlled prospective study.
Lafeber M, Grobbee DE, Schrover IM, et al., 2015, Comparison of a morning polypill, evening polypill and individual pills on LDL-cholesterol, ambulatory blood pressure and adherence in high-risk patients; a randomized crossover trial, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 181, Pages: 193-199, ISSN: 0167-5273
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- Citations: 41
Davies JE, Lacy P, Tillin T, et al., 2014, Excess Pressure Integral Predicts Cardiovascular Events Independent of Other Risk Factors in the Conduit Artery Functional Evaluation Substudy of Anglo-Scandinavian Cardiac Outcomes Trial, HYPERTENSION, Vol: 64, Pages: 60-68, ISSN: 0194-911X
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- Citations: 73
Lafeber M, Grobbee DE, Bots ML, et al., 2014, The Evening versus Morning Polypill Utilization Study: the TEMPUS rationale and design, EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY, Vol: 21, Pages: 425-433, ISSN: 2047-4873
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- Citations: 10
Thom S, Field J, Poulter N, et al., 2014, Use of a Multidrug Pill In Reducing cardiovascular Events (UMPIRE): rationale and design of a randomised controlled trial of a cardiovascular preventive polypill-based strategy in India and Europe, EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY, Vol: 21, Pages: 252-261, ISSN: 2047-4873
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- Citations: 29
Barron AJ, Hughes AD, Sharp A, et al., 2014, Long-Term Antihypertensive Treatment Fails to Improve E/e′ Despite Regression of Left Ventricular Mass An Anglo-Scandinavian Cardiac Outcomes Trial Substudy, HYPERTENSION, Vol: 63, Pages: 252-+, ISSN: 0194-911X
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- Citations: 20
Salam A, Webster R, Singh K, et al., 2014, TRIple pill vs Usual care Management for Patients with mild-to-moderate Hypertension (TRIUMPH): Study protocol, AMERICAN HEART JOURNAL, Vol: 167, Pages: 127-132, ISSN: 0002-8703
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- Citations: 14
Thom S, Rodgers A, 2014, Combination Pill for Cardiovascular Disease Reply, JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, Vol: 311, Pages: 93-94, ISSN: 0098-7484
Webster R, Patel A, Billot L, et al., 2013, Prospective meta-analysis of trials comparing fixed dose combination based care with usual care in individuals at high cardiovascular risk: The SPACE Collaboration, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 170, Pages: 30-35, ISSN: 0167-5273
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- Citations: 21
Hughes AD, Bathula R, Park C, et al., 2013, Microcirculatory rarefaction in South Asians - a potential mechanism for increased cardiovascular risk and diabetes, PLOS ONE, Vol: 8, ISSN: 1932-6203
People of South Asian descent have an increased risk of cardiovascular disease (CVD) and diabetes, but little is known aboutthe microcirculation in South Asian people despite evidence that this plays an important role in the aetiology of CVD. Wecompared the retinal microcirculation in a population-based sample of 287 middle-aged adults (144 European 143 SouthAsian) matched for age and sex. Retinal photographs were taken and analysed using a validated semi-automated programand microvascular measures were compared. Blood pressure, anthropometry and fasting bloods were also measured. SouthAsians had significantly fewer arteriolar and venular vessels and bifurcations. Arterioles and venules were longer andvenules were also more tortuous in South Asians. These differences were not explained by adjustment for traditional riskfactors including blood pressure, body mass index, diabetes or measures of insulin resistance. People of South Asiandescent have rarefaction of the retinal microcirculation compared to age-sex matched individuals of European descent.Reduced microvascular density could contribute to the elevated risk of CVD and impaired glucose tolerance in South Asianpeople.
Tapp RJ, Ness A, Williams C, et al., 2013, Differential Effects of Adiposity and Childhood Growth Trajectories on Retinal Microvascular Architecture, MICROCIRCULATION, Vol: 20, Pages: 609-616, ISSN: 1073-9688
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- Citations: 13
Brown CE, Mischak H, Abalat A, et al., 2013, Urinary proteomics can be predictive of cardiovascular events, JOURNAL OF HUMAN HYPERTENSION, Vol: 27, Pages: 647-647, ISSN: 0950-9240
Thom S, Poulter N, Field J, et al., 2013, Effects of a Fixed-Dose Combination Strategy on Adherence and Risk Factors in Patients With or at High Risk of CVD The UMPIRE Randomized Clinical Trial, JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, Vol: 310, Pages: 918-929, ISSN: 0098-7484
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- Citations: 286
Delles C, Brown CE, McCarthy NS, et al., 2013, Urinary Proteomic Biomarkers to Predict Cardiovascular Events, American-Heart-Association High Blood Pressure Research Scientific Sessions, Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0194-911X
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- Citations: 1
Zhang X, Luckham PF, Hughes AD, et al., 2013, Towards an understanding of the release behavior of temperature-sensitive liposomes: a possible explanation of the "pseudoequilibrium'' release behavior at the phase transition temperature, JOURNAL OF LIPOSOME RESEARCH, Vol: 23, Pages: 167-173, ISSN: 0898-2104
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- Citations: 8
Hughes AD, Park C, March K, et al., 2013, A randomized placebo controlled double blind crossover study of pioglitazone on left ventricular diastolic function in type 2 diabetes, INTERNATIONAL JOURNAL OF CARDIOLOGY, Vol: 167, Pages: 1329-1332, ISSN: 0167-5273
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- Citations: 16
Sever PS, Poulter NR, Chang CL, et al., 2013, Evaluation of C-Reactive Protein Before and On-Treatment as a Predictor of Benefit of Atorvastatin A Cohort Analysis From the Anglo-Scandinavian Cardiac Outcomes Trial Lipid-Lowering Arm, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, Vol: 62, Pages: 717-729, ISSN: 0735-1097
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- Citations: 26
Khamis R, Batty T, Wong I, et al., 2013, Dissecting the protective IgG anti-malondialdehyde-LDL (MDA-LDL) antibody response in a substudy of the Anglo Scandinavian Cardiac Outcomes Trial (ASCOT), Congress of the European-Society-of-Cardiology (ESC), Publisher: OXFORD UNIV PRESS, Pages: 141-141, ISSN: 0195-668X
Hughes AD, Park C, Davies J, et al., 2013, Limitations of augmentation index in the assessment of wave reflection in normotensive healthy individuals, PLOS One, Vol: 8, ISSN: 1932-6203
ObjectivesAugmentation index (AIx) is widely used as a measure of wave reflection. We compared the relationship between AIx and age, height and sex with ‘gold standard’ measures of wave reflection derived from measurements of pressure and flow to establish how well AIx measures wave reflection.Materials and MethodsMeasurements of carotid pressure and flow velocity were made in the carotid artery of 65 healthy normotensive individuals (age 21–78 yr; 43 male) and pulse wave analysis, wave intensity analysis and wave separation was performed; waveforms were classified into type A, B or C. AIx, the time of the first shoulder (Ts), wave reflection index (WRI) and the ratio of backward to forward pressure (Pb/Pf) were calculated.ResultsAIx did not correlate with log WRI or Pb/Pf. When AIx was restricted to positive values AIx and log WRI were positively correlated (r = 0.33; p = 0.04). In contrast log WRI and Pb/Pf were closely correlated (r = 0.66; p<0.001). There was no correlation between the Ts and the timing of Pb or the reflected wave identified by wave intensity analysis. Wave intensity analysis showed that the morphology of type C waveforms (negative AIx) was principally due to a forward travelling (re-reflected) decompression wave in mid-systole. AIx correlated positively with age, inversely with height and was higher in women. In contrast log WRI and Pb/Pf showed negative associations with age, were unrelated to height and did not differ significantly by gender.ConclusionsAIx has serious limitations as a measure of wave reflection. Negative AIx values derived from Type C waves should not be used as estimates of wave reflection magnitude.
Salam A, Stewart F, Singh K, et al., 2013, INterpreting the Processes of the UMPIRE Trial (INPUT): protocol for a qualitative process evaluation study of a fixed-dose combination (FDC) strategy to improve adherence to cardiovascular medications, BMJ OPEN, Vol: 3, ISSN: 2044-6055
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- Citations: 4
Elley CR, Gupta AK, Webster R, et al., 2012, The efficacy and tolerability of ‘polypills’: meta-analysis of randomised controlled trials, PLOS One, Vol: 7, ISSN: 1932-6203
BackgroundTo assess the blood pressure and lipid-lowering efficacy and tolerability of ‘polypills’ used in cardiovascular disease prevention trials.Methodology/Principal FindingsSystematic review and meta-analysis. Search strategy: The Cochrane Central Register of Controlled Trials, Medline, and PubMed databases were searched for eligible trials. Study inclusion criteria: Randomised controlled trials of at least six weeks duration, which compared a ‘polypill’ (that included at least one anti-hypertensive and one lipid-lowering medication) with a placebo (or one active component). Outcome measures: Change from baseline in systolic and diastolic blood pressures, and total and LDL-cholesterol; discontinuation of study medication and reported adverse effects. Of 44 potentially eligible studies, six trials (including 2,218 patients without previous cardiovascular disease) fulfilled the inclusion criteria. Compared with placebo, ‘polypills’ reduced systolic blood pressure by −9.2 mmHg (95% confidence interval (CI): −13.4, −5.0) diastolic blood pressure by −5.0 mmHg (95%CI: −7.4, −2.6), total cholesterol by −1.22 mmol/L (95%CI: −1.60, −0.84) and LDL-cholesterol by −1.02 mmol/L (95%CI: −1.37, −0.67). However, those taking a ‘polypill’ (vs. placebo or component) were more likely to discontinue medication (20% vs 14%) (Odds ratio: 1.5 (95% CI: 1.2, 1.9)). There was no significant difference in reported adverse effects amongst those on a ‘polypill’ (36% vs. 28%) (OR: 1.3 (95%CI: 0.7, 2.5)). There was high statistical heterogeneity in comparisons for blood pressure and lipid-lowering but use of random-effects and quality-effects models produced very similar results.Conclusions/SignificanceCompared with placebo, the ‘polypills’ reduced blood pressure and lipids. Tolerability was lower amongst those on ‘polypills’ than those o
Thom SA, Field J, Poulter NR, et al., 2012, Use of a Multidrug Pill In Reducing cardiovascular Events (UMPIRE), Scientific Sessions of the American-Heart-Association, Publisher: LIPPINCOTT WILLIAMS & WILKINS, Pages: 2781-2781, ISSN: 0009-7322
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- Citations: 1
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