Why worry about high blood pressure?

29.4.14: Listen to blood pressure specialist Donald Singer and pharmacist Ejaz Cheema in discussion with Annie Othen on BBC radio about blood pressure, knowing your numbers, tips on blood pressure measurement, why treatment is important, and how doctors, nurses and pharmacists can help to keep people with high blood pressure as healthy as possible.

High blood pressure is a very common preventable cause of stroke, heart attack and other serious diseases. These complications may at best cause disability and are major causes of preventable premature death in the UK and around the world.

For the public in general, the lower the blood pressure the better: most blood pressure-related heart attacks and strokes occur at blood pressure levels within what many still consider to be normal blood pressure.

A healthy lifestyle will help to keep blood pressure and other cardiovascular risk factors in check.  Keeping weight in check, regular exercise, minimising salt intake and moderation in alcohol, as well as eating healthy foods rich in fruit and vegetables all help, as does avoiding or stopping smoking.

For people with raised blood pressure, tests are important to rule out underlying causes and to identify other cardiovascular risk factors.

Blood pressure treatment is well-established as effective in helping to prevent or reduce severity of heart attack, stroke and other serious medical problems. However  blood pressure is still poorly controlled in many patients even in the most developed healthcare systems.

One of several reasons for poor blood pressure control is that many patients find it difficult to keep taking their tablets. Surprisingly, in people newly diagnosed with high blood pressure, as many as half may have stopped their tablets by 12 months.

It is as important to understand and address reasons for poor patient adherence with their medicines. These include not being sure of why blood pressure is important, reasons for choice of medicines, and concerns about possible or actual side effects of tablets.

Other contributory factors includes failure of prescribers to follow established national guidelines for choice of tablets and how they should be used singly or in combination. This risks exposing patients to avoidable side effects without achieving effective lowering of blood pressure.

An important element in approaches to improving adherence to blood pressure medicines is continuing education of health professionals and patients about high blood pressure and its treatment. Doctors, nurses and pharmacists can all play important roles in this.

Medicine and Kazakhstan

In the Western Kazakhstan regional capital city Aktobe this week with speakers on medical research from Switzerland, Italy Azerbaijan and Russia, joining local researchers for a  well-organised conference and series of Masterclasses for staff and students, hosted by Rector Bekmukhambetov. First a direct flight from London for an overnight stay in the old capital Almaty, with its snow-covered mountains. A Canadian captain provided the tannoy welcome on a new jet for the transfer to Aktobe, 2000km to the East. Aktobe was emerging from a winter of

White wagtail in central Aktobe

temperatures down to -35 deg C, still mounds of snow and ice in the shadows, a dusty breeze from the Steppe, buds  on the trees, and sparrows and white wagtails enjoying warm April sun.  

The Medical School in Aktobe, one of 5 in the country, has benefited from major recent investment in local hospitals and supporting equipment. Primary

Delegates at a Therapeutics Masterclass

Coronary Intervention for relevant acute coronary syndromes, complemented by acute thromobolysis for patients in transit from remote areas, mandatory HPV immunisation from the age of 13, outstanding neonatal intensive care provision, and advanced rehabilitation facilities, are examples of many areas of internationally competitive medical provision and practice.

Medical student presenters. Moderators seated from left: S Balmagambetova, D Singer, A Aliev

Research questions under discussion this week have included how Kazakhstan can meet the challenges and  medical consequences of the international epidemic of obesity, coping with the environmental consequences of the mineral and fossil fuel exploitation that is helping to fund the dramatic economic expansion in the country, neuropsychology in childhood, and the epidemiology and pathology of reproduction, of a range of cancers, and common and serious diseases of the cardiovascular system, the eye, and brain. External speakers discussed a range of internationally relevant topics, including advances in prion disease, new methods for early discovery of new beneficial and harmful targets for drugs, dealing with Multi-Drug Resistant tuberculosis, and new ultrastructural methods for identifying ageing in human oocytes.

Addressing these important questions for this huge and sparsely populated country - around 17

Local and international faculty at the Conference

million inhabitants in an area the size of Western Europe - will be further enabled with continued financial support made possible by the valuable natural resources in Kazakhstan,  and a new and expanding graduate researcher programme, strengthened by an increasing range of international academic research collaborations. 

There are major opportunities for further strengthening of clinical academic systems from increasing partnerships with international health-related organisations and new opportunities for external partnerships with agencies involved in drug regulation, in developing clinical management guidelines, and in other important aspects of health policy.

Hippocrates Prize NHS shortlist discussed on BBC World at One

Shortlists and results for commended poets in the Open, NHS and Young Poet sections have just been released for the 2014 Hippocrates Prize for Poetry and Medicine.

With a 1st prize for the winning poem in the Open and in the NHS category of £5,000, and £500 for the Young Poet award, the Hippocrates prize is one of the highest value poetry awards in the world for a single poem.

Listen to discussion about Hippocrates NHS shortlist between Hippocrates judge, Robert Francis QC, and the BBC’s Martha Kearney on the World at One on Thursday 10^th April.

Competing for the UK NHS 2014 Hippocrates £5000 first prize are dentist Paula Cunningham from Belfast, Valerie Laws from Whitley Bay, who has worked as a poet with pathologists and neuroscientists, and Ellen Storm, a trainee in paediatrics and child health in the Mersey region.

The 2014 Hippocrates Awards will be presented at the close of the 5th International Symposium on Poetry and Medicine in London on Saturday 10th May.

Press release about the Hippocrates Young Poet Award
http://hippocrates-poetry.org/news/press-releases-2/extraordinarily-assured-and.html

Press release about the Hippocrates International Open and NHS Awards
http://hippocrates-poetry.org/news/press-releases-2/the-personal-and-the-beauti.html

What next for treating flu?

Listen to my interview about anti-flu drugs with broadcaster Andrew Easton on BBC local radio.

Pandemics of flu in past decades have caused serious complications and high death rates, with the 1918 'Spanish flu' the most serious example. This has lead to major efforts by the pharmaceutical industry to develop effective antiviral treatment for flu, to complement prophylaxis from immunisation.

Efforts to find drug treatments are important as flu mutates regularly so that immunisation may not protect from new strains of the virus.

During the 2009 swine flu pandemic, large amounts of antiviral drugs were prescribed and stockpiled. 
A Cochrane review has now reported marked variability in the quality of data of clinical trials of drugs used to prevent and treat influenza and disappointing outcomes from higher quality studies. Many studies were reported to include important potential bias. Reasons included obvious differences in colour between placebo and active treatments in randomised controlled trials.

Serious outcome measures were often based on self-reporting, for example not using X-rays to confirm a presumptive diagnosis of pneumonia. And unpleasant side-effects of the treatment occurred in from ~1 in 25 to 1 in 90 patients, in particular headaches, vomiting and psychiatric abnormalities.
For the serious complication pneumonia, for studies in which X-ray confirmation was used, there appeared to be no benefit from active anti-viral treatment on pneumonia severity.

Although there was a reported ~10% reduction in severity of symptoms in adults and 1 in 6 shorter symptoms in children when drugs were given after the diagnosis, higher risk children - those this asthma, did not appear to experience this benefit on duration of symptoms.

There is now a presumption that alternative simpler and cheaper remedies such as paracetamol (acetaminophen) might be just as effective for symptom relief. The international incidence of flu is so high that trials to confirm that important question would not be difficult to complete rapidly.
Any such trials should use robust outcome measures, including recording admissions to hospital, confirming that flu diagnosis is correct (ie illness not due an infection such as RSV which is resistant to current flu antiviral agents), and serious complications are confirmed using tests such as X-rays.

A serious underlying issue arising from work by these Cochrane authors, and other assessments of safety and effective of drugs, was a delay of around 5 years in provision of trial data by one of the companies involved. Prompt access to all data is vital to ensure that the clinical and cost-effectiveness of drugs can be validated.

There are now important efforts underway from NGOs such as AllTrials, regulatory agencies and professional societies to improve transparency of access to company data by independent researchers.

BBC report

Guardian report

Out of Hospital Arrest and other Hippocrates NHS shortlisted poems

Listen to discussion about Out of Hospital Arrest and other Hippocrates NHS shortlisted poems: Hippocrates judge, Robert Francis QC in discussion with the BBC’s Martha Kearney on the World at One on Thursday 10^th April.

Shortlists and results for commended poets in the Open, NHS and Young Poet sections have just been released for the 2014 Hippocrates Prize for Poetry and Medicine.

With a 1st prize for the winning poem in the Open and in the NHS category of £5,000, and £500 for the Young Poet award, the Hippocrates prize is one of the highest value poetry awards in the world for a single poem.

Links below are for shortlisted commended poets, their biographies, and what inspired their poems.

Open and NHS Shortlists

Young Poet Shortlist

In the Open Awards, the judges agreed 21 Commendations for poets from seven countries.

Open Commendations

In the NHS Awards, the judges agreed 20 Commendations.

NHS Commendations

Poets from New York and South Africa, a trainee child health doctor, and a dentist from Belfast are among finalists for this year’s Hippocrates Prize for Poetry and Medicine. At £5000, in both Open and NHS categories, this is one of the highest value poetry awards in the world for a single poem.

Now in its 5th year, the short-listed entries for the 2014 Hippocrates Prize for Poetry and Medicine have been selected from over 1000 entries, from 31 countries by judges poet Philip Gross, barrister Robert Francis QC and Mumsnet Editor Sarah Crown.

Short-listed poets in the Open Category are poet Jane Draycott, publisher and poet Ailsa Holland, both from England, and Karel Nel, a former pastor and scientist from South Africa.

And competing for the UK NHS 2014 Hippocrates £5000 first prize are dentist Paula Cunningham from Belfast, Valerie Laws from Whitley Bay, who has worked as a poet with pathologists and neuroscientists, and Ellen Storm, a trainee in paediatrics and child health in the Mersey region.

The judges also agreed 20 commendations in the NHS category, and 21 in the Open International category, from England, Ireland, Scotland, Norway, the USA, New Zealand and Australia.

The winners will be announced at an International Symposium on Poetry and Medicine in London on Saturday May 10th.

Judge Philip Gross said: ‘Reading the stronger poems in the Open and the NHS categories, I see how many of their qualities they share. Dedicated poet or health professional – maybe each needs the same disciplines of observation and exactness, care and a right handling of emotions, the ability to get up close and yet step back and see it whole.’

Judge Sarah Crown commented: ‘We think of healthcare first and foremost as a scientific arena; a realm of dosages, diagnoses, instruments and odds. The real pleasure of these poems for me was the way in which they made the case for the place, within this arena, of the personal and the beautiful, too.

‘Reading them awakened me to the stories behind the science, and I found myself in tears on more than one occasion. Congratulations to everyone who submitted a poem, and particularly to the winners.’ 

Judge Robert Francis QC remarked "What a celebration of the partnership between patients and those who care for them and their shared will to overcome the frailties which we all have to face!"

Shortlisted for the £500 2014 Hippocrates Young Poet Prize are UK poets Joseph Davison-Duddles, Molly Garbutt, and Conor McKee, and US poet, Talin Tahajian from Belmont, Massachusetts. The winning entry will be announced at an International Symposium for Poetry and Medicine in London on Saturday 10th May.

This new International Hippocrates Prize for Young Poets is for an unpublished poem in English on a medical theme by poets aged 14 to 18 years. The 2014 Prize attracted entries from England, Ireland, and Scotland, Israel, Italy, Nigeria, South Africa and the USA. It is one of the most valuable poetry awards in the world for young poets.

This year’s poems were judged by adult and children’s author, and winner of the Geoffrey Faber Memorial Prize, Kit Wright.

Kit Wright said of the entered poems: ‘It was a remarkable experience to judge these poems, highly various in their approaches, both stylistically and in their choice of subject. The world of medicine is an extraordinarily rich one for the writer, and these young poets have produced some extraordinarily assured and compelling responses to it.’

The 2014 Hippocrates Awards will be presented at the close of the 5th International Symposium on Poetry and Medicine in London on Saturday 10th May.

Competing poets for the 2014 Hippocrates Awards came from 31 countries from 6 continents around the world. Entries have arrived from throughout the United Kingdom and the United States, and from Australia, Brazil, Canada, China, Czech Republic, France , Germany, India, Ireland, Israel, Italy , Kenya, Malta, New Zealand, Nigeria, Norway, Pakistan, Poland, South Africa, Singapore, Slovakia, Sri Lanka, Switzerland, The Netherlands, Trinidad and Zimbabwe.

Press release about the Hippocrates Young Poet Award

http://hippocrates-poetry.org/news/press-releases-2/extraordinarily-assured-and.html

Press release about the Hippocrates International Open and NHS Awards

http://hippocrates-poetry.org/news/press-releases-2/the-personal-and-the-beauti.html