Hypertension Epidemiology and Therapeutics

Hypertension is the most common preventable cause of premature death in the UK affecting over a quarter of adults – and over half of those over 60 years of age. Although current management guidelines focus on getting blood pressure down to a specific target, the risk associated with increasing blood pressure is continuous, with each 2 mmHg rise in systolic blood pressure associated with a 7% increased risk of mortality from ischaemic heart disease and a 10% increased risk of mortality from stroke.

PATHWAY Clinical Trial – (Prevention And Treatment of resistant Hypertension With Algorithm guided therapy) comprises three clinical trials of licensed medicines which aim to address some important areas of uncertainty in the current management of hypertension. This study is funded by the British Heart Foundation.

PATHWAY 1: Monotherapy vs Dual Therapy for initiating treamtent
PATHWAY 2: Optimal treatment of drug-resistant hypertension
PATHWAY 3: Comparison of single and combination diuretics in low-renin hypertension

The Glasgow Blood Pressure clinic at the Western Infirmary in Glasgow is one of the largest and the longest running blood pressure clinics in the world. Over 16,000 patients have been managed at this clinic since 1968 and the clinical database is now providing valuable insights into predictors of risk that will benefit hypertensive patients everywhere. Ongoing research at the Glasgow BP Clinic include assessment of predictors of mortality, blood pressure variability, ambulatory BP monitoring, social determinants of health etc.

Publications:

1. Paul L, Jeemon P, Hewitt J, McCallum L, Higgins P, Walters M, McClure J, Dawson J, Meredith P, Jones GC, Muir S, Dominiczak AF, Lowe G, McInnes GT, Padmanabhan S. Hematocrit predicts long-term mortality in a nonlinear and sex-specific manner in hypertensive adults. Hypertension 2012;60(3):631-8.
2. Kalra PR, Morley C, Barnes S, Menown I, Kassianos G, Padmanabhan S, Gupta S, Lang CC. Discontinuation of beta-blockers in cardiovascular disease: UK primary care cohort study. Int J Cardiol 2012 Jul 26.
3. Menown IB, Davies S, Gupta S, Kalra PR, Lang CC, Morley C, Padmanabhan S. Resting Heart Rate and Outcomes In PatientsWith Cardiovascular Disease: Where do we currently stand? Cardiovasc Ther 2012 Jul 20.
4. Lang CC, Gupta S, Kalra P, Keavney B, Menown I, Morley C, Padmanabhan S. Elevated heart rate and cardiovascular outcomes in patients with coronary artery disease: clinical evidence and pathophysiological mechanisms. Atherosclerosis 2010;212(1):1-8. Epub 2010 Jan 29. Review.
5. Paul L, Hastie CE, Li WS, Harrow C, Muir S, Connell JM, Dominiczak AF, McInnes GT, Padmanabhan S. Resting heart rate pattern during follow-up and mortality in hypertensive patients. Hypertension 2010;55(2):567-74.
6. Hastie CE, Padmanabhan S, Slack R, Pell AC, Oldroyd KG, Flapan AD, Jennings KP, Irving J, Eteiba H, Dominiczak AF, Pell JP. Obesity paradox in a cohort of 4880 consecutive patients undergoing percutaneous coronary intervention. Eur Heart J2010;31(2):222-6.
7. Stewart L, McInnes GT, Murray L, Sloan B, Walters MR, Morton R, Padmanabhan S, Reid JL, Morrison DS. Risks of socioeconomic deprivation on mortality in hypertensive patients. J Hypertens 2009;27(4):730-5.
8. Whiteley L, Padmanabhan S, Hole D, Isles C. Should diabetes be considered a coronary heart disease risk equivalent?: results from 25 years of follow-up in the Renfrew and Paisley survey. Diabetes Care 2005;28(7):1588-93.