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Dr Paul Padfield, Trustee

High Blood Pressure Foundation 15th Annual Report 2005

Message from Dr Paul Padfield, Trustee, High Blood Pressure Foundation, 2005

In last year’s annual report I identified the growing importance of self-monitoring of blood pressure as a means of assessing ongoing control of hypertension in the community.  Since that time we have developed local algorithms that should allow doctors in primary care the ability to properly utilise such technology in the management of their patients.  We have worked very closely with Dr Brian McKinstry (a research active general practitioner in Edinburgh) to look at how self monitoring of blood pressure compares with ambulatory monitoring in a pilot project within his and other practices.  Our expectation is that this will lead to a larger application for research funding from the Spring of next year to examine the practicability of more widespread use of remote management of high blood pressure.  We hope to link self-monitoring with modern wireless technology to allow ‘real time’ monitoring of BP control.  It is increasingly clear also that for some patients, those at high individual risk, the speed of achieving target blood pressure is important and the use of self monitors could shorten the time it takes to ensure  blood pressure control is achieved.

 

Over the last year we have continued our studies of the monitoring of blood pressure in a truly ambulatory setting and have applied this to the study of patients with diabetes mellitus.  Individuals can go about their normal daily activities while a monitor attached to their arm will record blood pressure throughout 24 hours.  Working with Dr Mark Strachan in the department of diabetes and with the help of a medical student, Miss Alison Heggie, we have explored the links between the 24-hour profile of blood pressure and the organ damage that occurs in patients with diabetes who are also hypertensive.  These studies have been presented at scientific meetings, with Diabetes UK in Glasgow and at the British Hypertension Society this autumn in Cambridge. 

 

A newly appointed specialist registrar, Dr Neil McGowan, is going to take this work further with prospective studies to address the possibility of specifically targeting the raised blood pressure that occurs during the night time in patients with diabetes and which appears to put them at peculiar risk of subsequent harm.  We have shown that the phenomenon of ‘non-dipping’ (where BP does not fall normally at night) is particularly common in patients with diabetes and we plan to assess the impact of lowering BP more aggressively at night on several markers of cardiovascular risk.

 

The HBPF continues its educational activities and in particular we plan a further large symposium for both clinicians and lay people on 16th March 2006.  There has been an ongoing debate within the medical profession as to how best one should treat high blood pressure.  The schools of thought range from one extreme which says that it does not matter how blood pressure is lowered, only that it is to the other end of the spectrum where it is argued that some (usually newer) anti-hypertensive agents (drugs that lower blood pressure) may deliver greater benefit to patients than others (despite similar effects on BP).  Such drugs are often more expensive and it is an important consideration for the NHS to decide whether or not some of the older agents, which are significantly cheaper, are inferior to some newer drug classes.  This will be the subject of a debate to be held at the Royal College of Physicians on 16 March next year.  Look out for adverts for this in the local press.  It is likely to prove an exciting symposium.

 

Dr Paul L Padfield