Measuring blood pressure over 24 hours provides more accurate results than traditional readings

NIHR |April 2018 |24-hour blood pressure readings better predict mortality

A collaboration between Spanish researchers, University College London and University College Hospital  has discovered that measuring blood pressure every 30 minutes over a period of 24 hours rather than simply at a GP’s appointment. The researchers used data from 63000 Spanish patients which were followed up for nearly a decade. The results of the study also indicate that taking readings in this way might also better diagnosis and management of high blood pressure.  
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According to the researchers  measuring blood pressure over 24 hours using an Ambulatory Blood Pressure Monitoring (ABPM) device, better predicts cardiovascular and all causes of death than pressure taken in the office/clinic. This is because blood pressure can vary during the course of a day. They found that using ABPM was a stronger predictor of all-cause and cardiovascular mortality than clinic blood-pressure measurements (NIHR).

Abstract

BACKGROUND

Evidence for the influence of ambulatory blood pressure on prognosis derives mainly from population-based studies and a few relatively small clinical investigations. This study examined the associations of blood pressure measured in the clinic (clinic blood pressure) and 24-hour ambulatory blood pressure with all-cause and cardiovascular mortality in a large cohort of patients in primary care.

METHODS

We analyzed data from a registry-based, multicenter, national cohort that included 63,910 adults recruited from 2004 through 2014 in Spain. Clinic and 24-hour ambulatory blood-pressure data were examined in the following categories: sustained hypertension (elevated clinic and elevated 24-hour ambulatory blood pressure), “white-coat” hypertension (elevated clinic and normal 24-hour ambulatory blood pressure), masked hypertension (normal clinic and elevated 24-hour ambulatory blood pressure), and normotension (normal clinic and normal 24-hour ambulatory blood pressure). Analyses were conducted with Cox regression models, adjusted for clinic and 24-hour ambulatory blood pressures and for confounders.

RESULTS

During a median follow-up of 4.7 years, 3808 patients died from any cause, and 1295 of these patients died from cardiovascular causes. In a model that included both 24-hour and clinic measurements, 24-hour systolic pressure was more strongly associated with all-cause mortality (hazard ratio, 1.58 per 1-SD increase in pressure; 95% confidence interval [CI], 1.56 to 1.60, after adjustment for clinic blood pressure) than the clinic systolic pressure (hazard ratio, 1.02; 95% CI, 1.00 to 1.04, after adjustment for 24-hour blood pressure). Corresponding hazard ratios per 1-SD increase in pressure were 1.55 (95% CI, 1.53 to 1.57, after adjustment for clinic and daytime blood pressures) for nighttime ambulatory systolic pressure and 1.54 (95% CI, 1.52 to 1.56, after adjustment for clinic and nighttime blood pressures) for daytime ambulatory systolic pressure. These relationships were consistent across subgroups of age, sex, and status with respect to obesity, diabetes, cardiovascular disease, and antihypertensive treatment. Masked hypertension was more strongly associated with all-cause mortality (hazard ratio, 2.83; 95% CI, 2.12 to 3.79) than sustained hypertension (hazard ratio, 1.80; 95% CI, 1.41 to 2.31) or white-coat hypertension (hazard ratio, 1.79; 95% CI, 1.38 to 2.32). Results for cardiovascular mortality were similar to those for all-cause mortality.

CONCLUSIONS

Ambulatory blood-pressure measurements were a stronger predictor of all-cause and cardiovascular mortality than clinic blood-pressure measurements. White-coat hypertension was not benign, and masked hypertension was associated with a greater risk of death than sustained hypertension. (Funded by the Spanish Society of Hypertension and others.)

The paper is in the New England Journal of Medicine 

Rotherham NHS staff may request it here 

Allied Health Professions supporting patient flow

This quick guide demonstrates how NHS emergency care, in particular patient flow through the health and care system, benefits from allied health professionals | NHS Improvement

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Bringing the AHP workforce into patient flow planning can improve quality, effectiveness and productivity.

Each section gives a brief overview of the contribution that AHPs have made to deliver safe, effective patient care and flow, followed by case studies which demonstrate how AHPs:

  • work in the community keeping people safe and well at home
  • ‘front door’ assess, diagnose and treat patients in emergency departments, ambulatory care and assessment units
  • support avoidance of hospital admission
  • enable early rehabilitation and reducing overnight admissions
  • drive ‘Home First’ (discharge to assess) to avoid in-hospital deconditioning of frail, older people.

Full detail: Quick guide: allied health professions supporting patient flow

Young people bullied online twice as likely to self-harm

A new study examines  the relationship between cyberbullying and self- harm (SH) and suicidal behaviour. The researchers reviewed the evidence and found victims of cyber bullying are twice as likely to self harm than their peers. They also noted perpetrators are at risk of suicidal behaviors and suicidal ideation when compared with nonperpetrators. 

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ABSTRACT

Background: Given the concerns about bullying via electronic communication in children and young people and its possible contribution to self-harm, we have reviewed the evidence for associations between cyberbullying involvement and self-harm or suicidal behaviors (such as suicidal ideation, suicide plans, and suicide attempts) in children and young people.Objective: The aim of this study was to systematically review the current evidence examining the association between cyberbullying involvement as victim or perpetrator and self-harm and suicidal behaviors in children and young people (younger than 25 years), and where possible, to meta-analyze data on the associations.

Methods: An electronic literature search was conducted for all studies published between January 1, 1996, and February 3, 2017, across sources, including MEDLINE, Cochrane, and PsycINFO. Articles were included if the study examined any association between cyberbullying involvement and self-harm or suicidal behaviors and reported empirical data in a sample aged under 25 years. Quality of included papers was assessed and data were extracted. Meta-analyses of data were conducted.

Results: A total of 33 eligible articles from 26 independent studies were included, covering a population of 156,384 children and young people. A total of 25 articles (20 independent studies, n=115,056) identified associations (negative influences) between cybervictimization and self-harm or suicidal behaviors or between perpetrating cyberbullying and suicidal behaviors. Three additional studies, in which the cyberbullying, self-harm, or suicidal behaviors measures had been combined with other measures (such as traditional bullying and mental health problems), also showed negative influences (n=44,526). A total of 5 studies showed no significant associations (n=5646). Meta-analyses, producing odds ratios (ORs) as a summary measure of effect size (eg, ratio of the odds of cyber victims who have experienced SH vs nonvictims who have experienced SH), showed that, compared with nonvictims, those who have experienced cybervictimization were OR 2.35 (95% CI 1.65-3.34) times as likely to self-harm, OR 2.10 (95% CI 1.73-2.55) times as likely to exhibit suicidal behaviors, OR 2.57 (95% CI 1.69-3.90) times more likely to attempt suicide, and OR 2.15 (95% CI 1.70-2.71) times more likely to have suicidal thoughts. Cyberbullying perpetrators were OR 1.21 (95% CI 1.02-1.44) times more likely to exhibit suicidal behaviors and OR 1.23 (95% CI 1.10-1.37) times more likely to experience suicidal ideation than nonperpetrators.

Conclusions: Victims of cyberbullying are at a greater risk than nonvictims of both self-harm and suicidal behaviors. To a lesser extent, perpetrators of cyberbullying are at risk of suicidal behaviors and suicidal ideation when compared with nonperpetrators. Policy makers and schools should prioritize the inclusion of cyberbullying involvement in programs to prevent traditional bullying. Type of cyberbullying involvement, frequency, and gender should be assessed in future studies.

Full reference:

The full article can be read at JMIR

Related: Science Daily Young victims of cyberbullying twice as likely to attempt suicide and self-harm, study finds

New hope for patients with migraine

Medscape | April 2018 | Erenumab Prevents Episodic Migraine in Refractory Patients

A new drug may be available soon for patients in England. Unlike other treatments which have been developed to treat blood pressure and then ‘repurposed’ to treat migraine, Erenumab, a monoclonal antibody migraine treatment, has been submitted for approval from drug regulators in both the US and Europe drug regulators. A decision is expected soon.  It was specifically developed to treat migraine,  Erenumab is a monthly subcutaneous injection to prevent migraine.

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The double-blind study included a trial of a migraine included patients from Europe (n equal to 246). The sample was predominantly female (81 per cent) with the average age of the participant being 44. The patients were randomly assigned to either the placebo or given Erenumab, with the drug being injected monthly  over the course of the trial (12-week) (via Medscape).  Erenumab limited the average number of migraine headaches experienced monthly by half for a third of the people who participated in the study.

Related: NICE Erenumab for preventing migraine [ID1188]

In the media: BBC News Migraine: New drug works when others fail, researchers say 

Multimorbidity: a priority for global health research

This report was undertaken to summarise the existing research evidence about the burden, determinants, prevention, and treatment of multimorbidity | The Academy of Medical Sciences

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Image source: acmedsci.ac.uk

The term multimorbidity  refers to the existence of multiple medical conditions in a single individual. For many regions of the world, there is evidence that a substantial, and likely growing, proportion of the adult population is affected by more than one chronic condition.

Health conditions that frequently group together include heart disease, high blood pressure, diabetes, cancer, depression, anxiety, chronic obstructive pulmonary disease (COPD) and chronic kidney disease.  Why this happens is poorly understood, making it difficult to predict which patients may be most in need of preventive or increased care.

The report also highlights how physical conditions, such as type 2 diabetes, can affect mental health, and vice versa. But the division between health services treating mental and physical health often means that patients with physical and mental conditions are at particular risk of poor care.

Full report: Multimorbidity: a priority for global health research | The Academy of Medical Sciences.

See also:

Women in a quarter of the UK still can’t access vital maternal mental health services

New maps launched today by the Maternal Mental Health Alliance show that pregnant women and new mothers in a quarter of the UK still cannot access lifesaving specialist perinatal mental health services.

background-2410669_1920According to new data, pregnant women and new mothers in 24% of the UK still have no access to specialist perinatal mental health services. In its press release, the Maternal Health Alliance makes the point that in the most serious cases, perinatal mental illness can be life threatening: suicide is a leading cause of death for women during pregnancy and one year after giving birth.

With more than 1 in 10 women developing a mental illness during pregnancy or within the first year after having a baby, it is important women with the most severe perinatal illnesses have access to vital specialist services wherever they live. If left untreated these illnesses can have a devastating impact on women and their families.

Full press release: Women in a quarter of the UK still can’t access vital maternal mental health services

Full detail: UK Specialist Perinatal Mental Health Community Teams (2017 data)

Related: Women across UK denied mental healthcare around childbirth, say doctors | The Guardian

A new national approach to large-scale change?

Developing new models of care in the PACS vanguards: a new national approach to large-scale change? | The Kings Fundlight-bulbs-1125016_1920This independent report was commissioned by NHS England as part of a package of support provided to primary and acute care system (PACS) vanguard sites by The King’s Fund. The PACS model is an attempt to bring about closer working between GPs, hospitals, community health professionals, social care and others.

The report offers a unique set of first-hand perspectives into the experience of those leading a major programme at the national level and those living it at the local level. The insights shared will be invaluable to those constructing future national support programmes intended to facilitate transformation in local health and care systems. The lessons learned will also be highly relevant to those involved in the ongoing implementation of PACS and similar models.

Full report: Developing new models of care in the PACS vanguards: a new national approach to large-scale change?

See also: An international perspective on developing new models of care in the PACS vanguards