New blood pressure checks at home

24 August 2011 Last updated at 07:01 GMT By Helen Briggs Health editor, BBC News website Patient Sheila Milson tries out the blood pressure recording device. Prof Mark Caulfield, from Queen Mary University of London, explains how works.

Patients thought to have high blood pressure should have the diagnosis confirmed at home, according to new guidelines.

Patients in England and Wales will be offered extra checks using a mobile device that records blood pressure over 24 hours, says the watchdog NICE.

A quarter of patients may find visiting a GP stressful, leading to misdiagnosis and being given drugs they do not need.

The move could save the NHS £10.5m a year, predictions suggest.

High blood pressure (blood pressure of 140/90mmHg or more) affects about a quarter of all adults in the UK. It is a leading risk factor for heart disease or stroke and costs the NHS about £1bn a year in drugs alone.

Currently, most patients found to have high blood pressure for the first time are given a formal diagnosis if their blood pressure is raised at two subsequent visits to the doctor.

They may then be prescribed medication to lower their blood pressure.

Day and night

Research suggests, however, that about a quarter of patients actually have "white coat" hypertension - where blood pressure is raised temporarily due to stress.

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This new guidance will refine the way we test and treat people for hypertension, particularly by helping to identify people suffering from 'white coat' hypertension”

End Quote Cathy Ross Senior cardiac nurse at the British Heart Foundation Now, the National Institute for Health and Clinical Excellence (NICE) has advised doctors in England and Wales to move towards "ambulatory" monitoring of patients at home, using a device that automatically takes blood pressure readings every 30 minutes day and night.

Around one in 10 GPs are already offering ambulatory monitoring, either directly or by referring patients to a hospital specialist.

The new guidelines were issued at the same time as the publication of a research study in The Lancet.

One of the authors of the paper, Professor Richard McManus of the University of Birmingham, said: "This research shows that ambulatory blood pressure monitoring at the time of diagnosis of high blood pressure would allow better targeting of treatment and is cost-saving.

"Ambulatory monitoring is already available in some general practices and we have shown that its widespread use would be better for both patients and the clinicians looking after them.

"Treatment with blood pressure lowering medication is usually lifelong and so it is worth getting the decision to start right in the first place."

It is expected to take about a year to implement the advice at a net cost of about £2.5m. However, in the long-term the costs will be recouped, say experts, eventually saving about £10.5m a year.

'More accurate'

Cathy Ross, senior cardiac nurse at the British Heart Foundation, said the number of people with high blood pressure in the UK was "staggering".

"Some 12 million people are diagnosed with the condition and it is estimated another 5.7 million people have it but are unaware. It's a major risk factor for heart disease and strokes so it's crucial we do all we can to get people diagnosed and properly treated as soon as possible.

"This new guidance will refine the way we test and treat people for hypertension, particularly by helping to identify people suffering from 'white coat hypertension'.

"It doesn't mean that current methods aren't working, only that they can be improved further. Anyone currently concerned about their blood pressure or treatment should speak to their GP or practice nurse."

Professor Bryan Williams from the University of Leicester, chairman of NICE's Guideline Development Group, told the BBC there would be an "upfront cost" of introducing the ambulatory equipment.

But he added: "When you offset that against the reduced treatment costs of people who don't require treatment, and the reduced number of visits to doctors, we estimate that the NHS within about four or five years will save £10m.

"So it's a win-win situation for patients because it's a better way of making a diagnosis and the NHS actually saves money."

British Hypertension Society president Professor Mark Caulfield said the move was supported by research.

He said: "We've recommended that if high readings are found in the practice, that a 24-hour blood pressure monitor is worn because we found that the evidence now makes it very clear to us that this is a much more precise way of diagnosing high blood pressure."

In response to the new guidelines, Health Minister Anne Milton said: "These guidelines show that the use of innovations such as ambulatory monitors can provide more accurate blood pressure readings for patients as they go about their daily lives.

"This is not only better for patients, but also a better use of NHS resources."

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Hazare heaps pressure on India PM

22 August 2011 Last updated at 05:54 GMT The spontaneous outbreak of public support has become a matter of deep concern for the Indian government. Indian anti-corruption activist Anna Hazare has called on the government to pass a new anti-graft law or quit.

He has been on a public hunger strike since last Tuesday. An aide said he had lost 5kg, but was in good health.

Thousands of supporters are gathered at the vast Ram Lila Maidan grounds in the capital, Delhi, where Mr Hazare is conducting his fast.

Meanwhile, Prime Minister Manmohan Singh has said the government is open to talks with the 74-year-old activist.

Mr Hazare wants to force the government to strengthen an anti-corruption bill, which he regards as too weak.

He was released from Tihar jail on Friday after his arrest last Tuesday sparked mass protests across India.

On Thursday, he agreed to a police offer permitting him to go on hunger strike for 15 days.

He had previously vowed to remain in custody unless he was permitted to resume the protest which triggered his arrest. His campaign against graft has struck a chord with many Indians.

Massive protests

Tens of thousands of supporters marched from the Delhi monument India Gate to the Ram Lila ground on Sunday.

Continue reading the main story Following a hunger strike by Anna Hazare in April, the government agreed to draft the Jan Lokpal (Citizens' Ombudsman) bill. The final bill incorporates 34 of the 40 principles set out by Mr Hazare, but he and other activists have rejected itMr Hazare says the ombudsman should have the power to investigate the prime minister and senior judges. The government refuses to include them, saying their authority will be erodedMr Hazare wants the ombudsman to be able to investigate MPs accused of taking bribes to vote or ask questions in parliament. The government says such probes should be carried out by MPsDozens of protesters were detained after they demonstrated near the prime minister's house.

Thousands of people also joined a rally in support of Mr Hazare in Mumbai (Bombay) and protests were reported from the cities of Lucknow, Chandigarh, Ahmedabad and Surat.

This upsurge of support saw the authorities struggling to open a channel for communication with Mr Hazare.

On Saturday, PM Singh said the government was open to dialogue with Mr Hazare.

"There is a lot of scope for give and take... We are open to discussion and dialogue," Mr Singh said.

Reports said the government has roped in a senior bureaucrat from Maharashtra state, Umesh Chandra Sarangi, to negotiate with Mr Hazare.

"I had a few meetings with Mr Hazare over the Lokpal [ombudsman] bill. I have conveyed to him the views of the government. I am meeting him again on Monday," Mr Sarangi was quoted by the Times of India newspaper as saying.

Mr Hazare's supporters, however, said there had been no progress in resolving the standoff as the government had not made any fresh proposals.

Correspondents say Mr Hazare's fast has become a major embarrassment for the government and unless a compromise is found soon, it will further erode the credibility of the government.

String of scandals

Mr Hazare says the government's proposed anti-corruption bill is weak and wants his own tougher version to be passed by parliament.

Prime Minister Manmohan Singh has accused Mr Hazare of trying to circumvent democracy by demanding the overhaul of the bill.

But the spontaneous outbreak of public support has become a matter of deep concern for Mr Singh's administration.

India has recently been hit by a string of high-profile corruption scandals which critics say is evidence of a pervasive culture of corruption in Mr Singh's administration.

A recent survey said corruption in Asia's third largest economy had cost billions of dollars and threatened to derail growth.

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New blood pressure device hailed

21 February 2011 Last updated at 00:16 GMT A sensor in the watch records the pulse wave of the artery A device which can be worn like a watch could revolutionise the way blood pressure is monitored in the next few years, scientists say.

Researchers at the University of Leicester and in Singapore have developed a device to measure pressure in the largest artery in the body.

Evidence shows it gives a much more accurate reading than the arm cuff.

The technology is funded by the Department of Health and backed by Health Secretary Andrew Lansley.

It works by a sensor in the watch recording the pulse wave of the artery, which is then fed into a computer together with a traditional blood pressure reading from a cuff.

Scientists are then able to read the pressure close to the heart, from the aorta.

Professor Bryan Williams, from the University of Leicester's department of cardiovascular sciences at Glenfield Hospital, said: "The aorta is millimetres away from the heart and close to the brain and we have always known that pressure here is a bit lower than in the arm.

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This is a great example of how research breakthroughs and innovation can make a real difference to patients' lives”

End Quote Andrew Lansley Health Secretary "Unless we measure the pressure in the aorta we are not getting an appreciation of the risks or benefits of treatment."

He said the device would "change the way blood pressure has been monitored for more than a century" and he expected the technology to be used in specialist centres soon, before being "used much more widely" within five years.

"The beauty of all of this is that it is difficult to argue against the proposition that the pressure near to your heart and brain is likely to be more relevant to your risk of stroke and heart disease than the pressure in your arm," he said.

But it was important to ensure the new device was as small as possible to encourage clinicians and patients to use it, he added.

The research work was funded by the Department of Health's National Institute for Health Research (NIHR).

The NIHR invested £3.4m, with a further £2.2m of funding coming from the Department of Health, to establish a Biomedical Research Unit at Glenfield Hospital in Leicester.

The traditional blood pressure cuff on the upper arm is known not to give a completely accurate reading

The university collaborated with the Singapore-based medical device company HealthSTATS International.

Dr Choon Meng Ting, chairman of HealthSTATS, said: "This study has resulted in a very significant translational impact worldwide as it will empower doctors and their patients to monitor their central aortic systolic pressure easily, even in their homes and modify the course of treatment for blood pressure-related ailments."

Mr Lansley said the device was "a great example of how research breakthroughs and innovation can make a real difference to patients' lives".

Judy O'Sullivan, senior cardiac nurse at the British Heart Foundation, said previous research had shown that measuring pressure close to the heart was a better indicator of the effectiveness of treatment for high blood pressure than the standard method.

"However, further research is needed before we can be certain of its superiority in the doctor's surgery," she said.

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Bomb expert was 'under pressure'

9 February 2011 Last updated at 15:05 GMT Staff Sgt Olaf Schmid made safe 64 bombs during a five-month tour of duty A bomb disposal expert appeared "under pressure" and "rushed" on the day he died in a bomb blast in Afghanistan, an inquest has heard.

Staff Sgt Olaf Schmid, from Truro in Cornwall, died disarming a roadside bomb in November 2009.

Cpl Thomas Stace told the inquest the "inspirational leader" appeared "somewhat impatient" as he defused explosives on the day of his death.

The inquest at Truro Coroner's Court is expected to last two days.

Staff Sgt Schmid, who had diffused 64 improvised explosive devices (IEDs) in Afghanistan, had made a comment to a colleague about speeding up, Cpl Stace said.

However, in written evidence he told the inquest the pressure was not imposed by Army chiefs.

'Pulled wire'

"I think he was under pressure to deal with them all and that it was a self-imposed pressure," he said.

Sapper Craig Butterworth, who witnessed the death, described Staff Sgt Schmid as a "total inspiration" but said he had also noticed signs of stress.

The IED which killed the disposal expert instantly was the fourth device tackled that day, the inquest was told.

Colleagues said he pulled a wire from the ground, before turning round to them and saying "you didn't see me do that, did you?".

This was "very unusual" they said, but they trusted him completely because of his professionalism and experience.

Sapper Butterworth added: "On that day it occurred to me that he was slightly rushed.

"I could only think that this was because it was his last day before going home for rest and recuperation."

'Come home'

L/Cpl Gary Parsons told the inquest about a telephone conversation between Staff Sgt Schmid and his five-year-old stepson, Laird.

During the conversation, Laird had said "Daddy, time to come home", he added.

The inquest also heard evidence from pathologist Nicholas Hunt that Staff Sgt Schmid had fainted while on duty on 14 September - two months before he was killed - but was in good health.

The 30-year-old soldier, who had made his home in Winchester, Hampshire, died the day before he was due to return to the UK.

Known as Oz, Staff Sgt Schmid had been part of the 11 Explosive Ordnance Disposal Regiment, based in Didcot, Oxfordshire.

He was awarded a posthumous George Cross, which his widow Christina accepted in a ceremony last June.

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