Papers by Angus Nightingale
The FASEB Journal, 2014
Studies have revealed a role for pro-inflammatory effector-like CD3+ T cells in the pathogenesis ... more Studies have revealed a role for pro-inflammatory effector-like CD3+ T cells in the pathogenesis of experimental hypertension. Despite these observations, our knowledge of the role that T cells and...
Appendix 4. Subgroup analyses. (DOCX 851Â kb)
Appendix 1. Literature search. (DOCX 18Â kb)
Appendix 3. Funnel plots. (DOCX 41Â kb)
s from the 2017 Annual Scientific Meeting of the British and Irish Hypertension Society (BIHS) Jo... more s from the 2017 Annual Scientific Meeting of the British and Irish Hypertension Society (BIHS) Journal of Human Hypertension (2017) 31, 657–686; doi:10.1038/jhh.2017.63 The Technology and Innovation Centre, University of Strathclyde, Glasgow. 11-13 September 2017 Conference Organizer: In Conference Ltd. http://bihsevents.org/ Presenting author names are underlined in the contributor lists. Sponsorship: Funding for the publication of this supplement was provided by the British and Irish Hypertension Society for the advancement of knowledge and dissemination of information concerning the pathophysiology, epidemiology, detection, investigation and treatment of arterial hypertension and related vascular diseases. O – 1 Trends for prevalence and incidence of resistant hypertension: a population based cohort study in the UK 1995-2015 Sarah-Jo Sinnott, Liam Smeeth, Elizabeth Williamson, Ian Douglas London School of Hygiene and Tropical Medicine, London, United Kingdom Introduction: There i...
BMJ Case Reports
We herein report the case of a 53-year-old man who was historically diagnosed with hypertrophic c... more We herein report the case of a 53-year-old man who was historically diagnosed with hypertrophic cardiomyopathy (HCM) and was lost to follow-up, before presenting with end-stage heart failure. This was initially suspected as dilated cardiomyopathy and then ‘burnt-out phase’ of HCM but subsequently the underlying diagnosis was Fabry disease. Fabry disease is an uncommon lysosomal-storage disease due to reduced or absent activity of the alpha-galactosidase A enzyme. Cardiac involvement most frequently comprises left ventricular hypertrophy. Early treatment of the underlying condition with enzyme replacement therapy may prevent the progression to end-stage heart failure. Fabry disease should be considered in all patients presenting with a clinical phenotype of HCM and a historical diagnosis should be re-evaluated in light of new diagnostic tools. Untreated Fabry can progress to a ‘burnt out’ phase, whereby initial hypertrophy undergoes eccentric remodelling to a dilated, severely impair...
Imaging
CT-FFR with computerised tomography coronary angiography (CTCA) against the gold standard of ICA ... more CT-FFR with computerised tomography coronary angiography (CTCA) against the gold standard of ICA in different realworld patient groups. Methods We conducted a retrospective study of 477 patients referred for CTCA or CT-FFR for investigation of possible coronary ischaemia. Patients were excluded if the image quality was poor or inconclusive. Patient-based PPV was calculated to detect or rule out significant CAD, defined as more than 70% stenosis on ICA. A sub-analysis of PPV by indication for scan was also performed. Patients that underwent invasive non-hyperaemic pressure wire measurements had their iFR or RFR compared with their CT-FFR values. Results In a patient-based analysis, the overall PPV was 59.3% for CTCA and 76.2% for CT-FFR. This increased to 81.0% and 86.7% respectively for patients with stable angina symptoms. In patients with atypical angina symptoms, CT-FFR considerably outperformed CTCA with a PPV of 61.3% vs. 37.5%. There was not a linear relationship between invasive pressure wire measurement and CT-FFR value (r=0.23, p=0.265). Conclusion The PPV of CTCA and CT-FFR is lower in the real-world than in previously published trials, partly due to the heterogeneity of indication for the scan. However, in patients with typical angina symptoms, both are reliable diagnostic tools to determine the presence of clinically significant coronary stenoses. CT-FFR significantly outperforms CTCA in patients with more atypical symptoms and the targeted use of CT-FFR in this group may help to avoid unnecessary invasive procedures.
Valve Disease/Pericardial Disease/Cardiomyopathy
Background Ischaemic mitral regurgitation (MR) is a known complication of ST elevation myocardial... more Background Ischaemic mitral regurgitation (MR) is a known complication of ST elevation myocardial infarction (STEMI). There is a paucity of evidence on the impact of acutely revascularised STEMI on the mitral valve. The current ESC and ACC guidelines do not specifically advise a management strategy in this cohort. The aim of this study is to delineate the effect of STEMI on the mitral valve, identify predictors of MR and compare mortality between these groups. Methods In this observational registry study, we analysed 1122 consecutive patients presenting with STEMI who underwent primary PCI between April 2014 and April 2016. We identified predictors of significant MR (moderate or severe) and compared the mortality risk in MR group vs no MR group. Statistical analysis was done on SPSS. Results Of the 1122 patients identified at baseline (mean age 64±13 years, and 76% male), 94 were excluded due to missing echo data. 62 patients (6%) were found to have significant MR. Patients’ with significant MR were on average 10 years older than patients with no MR (95% CI =6.7 –−13.13; p<0.001). 18% of patients with LVEF <40% had significant MR compared to 3% with EF >40% (p<0.001). Although 76% of the sample population were male, females were shown to have a proportionally higher prevalence of MR and higher all-cause mortality (p=0.0179; p=0.0048 ) compared with males. All-cause mortality at the time of data collection was 19% in MR group vs 5% in no MR group. On a multivariate analysis; age, LV ejection fraction, renal impairment and non-smoker status were all shown to be significant predictors for ischaemic MR. Over a mean follow up of 2.3 years, 8% of the patients died, with significantly higher mortality in moderate-severe MR group compared with no MR group (Log rank 13.4, p<0.001). (Kaplan Meier graph). Conclusion Acute MR was found to be a significant predictor of mortality following STEMI. 3% of patients with LVEF >40% were found to have significant MR and may benefit from a repeat echocardiogram at follow-up thereby guiding future management. Prospective multicenter trials are warranted to confirm the finding. Abstract 79 Figure 1
Journal of Hypertension
Objective: Non-adherence to medication is present in ≥50% of patients with apparent treatment res... more Objective: Non-adherence to medication is present in ≥50% of patients with apparent treatment resistant hypertension. We examined the factors associated with non-adherence as detected by an LC-MS/MS based urine antihypertensive drug assay. Methods: All urine antihypertensive test results, carried out for uncontrolled hypertension (BP persistently >140/90 mmHg) between January 2015 and December 2016 at a single toxicology laboratory were analysed. Drugs detected were compared to the antihypertensive drugs prescribed. Patients were classified as adherent (all drugs detected), partially nonadherent (≥1 prescribed drugs detected) or completely non-adherent (no drugs detected). Demographic and clinical parameters were compared between the adherent and non-adherent groups. Binary logistic regression analysis was performed to determine association between non-adherence and demographic and clinical factors. Results: Data on 300 patients from 9 hypertension centres across the UK were analysed. The median age was 59 years, 47% female, 71% Caucasian , median clinic BP was 176/95 mmHg and the median number of antihypertensive drugs prescribed was four. One hundred and sixty-six (55%) were non-adherent to prescribed medication with 20% of these being completely non-adherent. Non-adherence to antihypertensive medication was independently associated with younger age, female gender, number of antihypertensive drugs prescribed, total number of all medications prescribed (total pill burden) and prescription of a calcium channel blocker. Conclusion: This LC-MS/MS urine analysis-based study suggests the majority of patients with apparent treatment resistant hypertension are non-adherent to prescribed treatment. Factors that are associated with non-adherence, particularly pill burden, should be taken into account while treating these patients.
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Journal of Human Hypertension
BIHS. https://bihsoc.org/events/annual-scientific-meeting/ All content was reviewed and approved ... more BIHS. https://bihsoc.org/events/annual-scientific-meeting/ All content was reviewed and approved by members of the British and Irish Hypertension Society, which held full responsibility for the abstract selections. Sponsorship: Funding for the publication of this supplement was provided by the British and Irish Hypertension Society for the advancement of knowledge and dissemination of information concerning the pathophysiology, epidemiology, detection, investigation and treatment of arterial hypertension and related vascular diseases.
Physiological measurement, Jan 7, 2018
Objective Hypertension is associated with reduced cerebral blood flow, but it is not known h... more Objective Hypertension is associated with reduced cerebral blood flow, but it is not known how this impacts on wave dynamics or potentially relates to arterial morphology. Given the location of the internal carotid artery (ICA) and risks associated with invasive measurements, wave dynamics in this artery have not been extensively assessed in vivo. This study explores the feasibility of studying wave dynamics in the internal carotid artery non-invasively. Approach Normotensive, uncontrolled and controlled hypertensive participants were recruited (daytime ambulatory blood pressure <135/85mmHg and >135/85mmHg, respectively; n=38). Wave intensity, reservoir pressure and statistical shape analyses were performed on the right ICA and ascending aorta high-resolution phase-contrast magnetic resonance angiography data. Main Results Wave speed in the aorta was significantly lower in normotensive compared to hypertensive participants (6.7±1.8 vs. 11...
European radiology, Jan 19, 2018
Left atrial enlargement (LAE) predicts cardiovascular morbidity and mortality. Impaired LA functi... more Left atrial enlargement (LAE) predicts cardiovascular morbidity and mortality. Impaired LA function also confers poor prognosis. This study aimed to determine whether left ventricular (LV) interstitial fibrosis is associated with LAE and LA impairment in systemic hypertension. Following informed written consent, a prospective observational study of 86 hypertensive patients (49 ± 15 years, 53% male, office SBP 168 ± 30 mmHg, office DBP 97 ± 4 mmHg) and 20 normotensive controls (48 ± 13 years, 55% male, office SBP 130 ± 13 mmHg, office DBP 80 ± 11 mmHg) at 1.5-T cardiovascular magnetic resonance was conducted. Extracellular volume fraction (ECV) was calculated by T1-mapping. LA volume (LAV) was measured with biplane area-length method. LA reservoir, conduit and pump function were calculated with the phasic volumetric method. Indexed LAV correlated with indexed LV mass (R = 0.376, p < 0.0001) and ECV (R = 0.359, p = 0.001). However, ECV was the strongest significant predictor of LAE...
Systematic reviews, Jan 31, 2018
We estimated the effectiveness of serial B-type natriuretic peptide (BNP) blood testing to guide ... more We estimated the effectiveness of serial B-type natriuretic peptide (BNP) blood testing to guide up-titration of medication compared with symptom-guided up-titration of medication in patients with heart failure (HF). Systematic review and meta-analysis of randomised controlled trials (RCTs). We searched: MEDLINE (Ovid) 1950 to 9/06/2016; Embase (Ovid), 1980 to 2016 week 23; the Cochrane Library; ISI Web of Science (Citations Index and Conference Proceedings). The primary outcome was all-cause mortality; secondary outcomes were death related to HF, cardiovascular death, all-cause hospital admission, hospital admission for HF, adverse events, and quality of life. IPD were sought from all RCTs identified. Random-effects meta-analyses (two-stage) were used to estimate hazard ratios (HR) and confidence intervals (CIs) across RCTs, including HR estimates from published reports of studies that did not provide IPD. We estimated treatment-by-covariate interactions for age, gender, New York H...
Hypertension (Dallas, Tex. : 1979), 2018
An exaggerated blood pressure (BP) response to maximal exercise is an independent risk factor for... more An exaggerated blood pressure (BP) response to maximal exercise is an independent risk factor for cardiovascular events and mortality. It is unclear whether treating BP to guideline recommended levels could normalize the rise in BP during exercise, which is mediated by the metaboreflex. We aimed to assess the BP response to incremental exercise testing and metaboreflex activation in treated-controlled hypertension (n=16), treated-uncontrolled hypertension (n=16), and untreated hypertension (n=11) and 16 control participants with normal BP (n=16). All groups were matched for age and body mass index. BP was measured during an incremental Vo peak test on a cycle ergometer and during metaboreflex isolation using postexercise ischemia. Data were analyzed using 2-way ANOVA with Tukey test for multiple comparisons. Aerobic fitness was similar among groups (=0.97). The rise in absolute systolic BP from baseline at peak exercise was similar in controlled, uncontrolled, and untreated hyperten...
Journal of clinical hypertension (Greenwich, Conn.), Jan 8, 2018
We investigate the impact of dipper status on cardiac structure with cardiovascular magnetic reso... more We investigate the impact of dipper status on cardiac structure with cardiovascular magnetic resonance (CMR). Ambulatory blood pressure monitoring and 1.5T CMR were performed in 99 tertiary hypertension clinic patients. Subgroup analysis by extreme dipper (n = 9), dipper (n = 39), non-dipper (n = 35) and reverse dipper (n = 16) status was performed, matched in age, gender and BMI. Left ventricular (LV) mass was significantly higher for extreme dippers than dippers after correction for covariates (100 ± 6 g/mvs 79 ± 3 g/m, P = .004). Amongst extreme dippers and dippers (n = 48), indexed LV mass correlated positively with the extent of nocturnal blood pressure dipping (R = .403, P = .005). On post-hoc ANCOVA, the percentage of nocturnal dip had significant effect on indexed LV mass (P = .008), but overall SBP did not (P = .348). In the tertiary setting, we found a larger nocturnal BP drop was associated with more LV hypertrophy. If confirmed in larger studies, this may have implicatio...
Health Technology Assessment
Background Heart failure (HF) affects around 500,000 people in the UK. HF medications are frequen... more Background Heart failure (HF) affects around 500,000 people in the UK. HF medications are frequently underprescribed and B-type natriuretic peptide (BNP)-guided therapy may help to optimise treatment. Objective To evaluate the clinical effectiveness and cost-effectiveness of BNP-guided therapy compared with symptom-guided therapy in HF patients. Design Systematic review, cohort study and cost-effectiveness model. Setting A literature review and usual care in the NHS. Participants (a) HF patients in randomised controlled trials (RCTs) of BNP-guided therapy; and (b) patients having usual care for HF in the NHS. Interventions Systematic review: BNP-guided therapy or symptom-guided therapy in primary or secondary care. Cohort study: BNP monitored (≥ 6 months’ follow-up and three or more BNP tests and two or more tests per year), BNP tested (≥ 1 tests but not BNP monitored) or never tested. Cost-effectiveness model: BNP-guided therapy in specialist clinics. Main outcome measures Mortalit...
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Papers by Angus Nightingale