Alister McNeish (educator)
Lecturer in cardiovascular pharmacology at the Reading School of Pharmacy, University of Reading. Presenter on the "Heart Health: A Beginners Guide to Cardiovascular Disease" module.
Location Reading UK
Activity
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Indeed nutrition and exercise are vital in prevention of cardiovascular and other diseases - my research is actually into omega-3 fatty acids in vascular function.
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Alister McNeish (educator) made a comment
Worth noting that since this course was originality ran the guidance has changed slightly in late 2019. In the UK diuretics are now interchangeable with other drugs at step 2 (so could be A+C, A+D or C+D) based around both patient choice and what is effective for that patient
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They really are great for primary anf secondary prevention of cardiac events and in heart failure. Interestingly for hypertension while they are very good at lowering the blood pressure the latest research shows they don't stop the vascular remodelling (thickening of the blood vessels), it seems that angiotensin receptor blockers do, and that may be another...
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Alister McNeish (educator) made a comment
I really liked the discussion on distraction, multi tasking and how it leads to reduction in performance, its nice to realise that in a away being aware of this and instead focussing on a task is a form of mindfulness.
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Alister McNeish (educator) made a comment
Hi I am Alister and I would like to learn more bout the science behind mindfulness and see if I can use it both in in my private and professional lives
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It is whatever value is high that dictates the diagnosis, as you point out your systolic can be near normal but you diastolic high
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We do teach the palpitation method but it only gives you the systolic value, as you say useful in some situations and also in surgery with small children.
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Interesting! sildenafil (Viagra) was actually pretty effective, however it wasn't used in and coronary heart disease mainly as it could cause dangerously low blood pressure when combined with other medications used in these diseases. It is also used for several other diseases (including pulmonary hypertension) .
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Alister McNeish (educator) made a comment
ECG can give diagnostic properties of the heart and help to identify problems and changes in function. Therefore is useful in both emergency and chronic situations
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Alister McNeish (educator) made a comment
I am a pharmacology lecturer wishing to learn ,more about the interpretation of ECGs and refresh my knowledge
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Thank you all for the lovely comments, I hope you have found the curse interesting and informative
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He is still alive due to excellent treatment from the NHS and support from the BHF. Thankfully due to research and treatment dying form a heart attack is becoming less common. I am glad you want to learn more.
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Alister McNeish (educator) made a comment
some interesting discussion here!
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Its important to know that correct diagnosis of hypertension should include 24 hour monitoring to account for things like white coat syndrome
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You can ask to have your blood pressure checked when you go to the doctor, it does not take long and most will oblige.
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Exercise and diet can have an effect and can certainly help prevent you getting high blood pressure in the first place. Once you have high blood pressure in the clinically defined range you may need the medications for life even if you have adjusted your lifestyle. If you gain control of your blood pressure you may want to discuss trying to remove a treatment...
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Both fall under the "A" category of these normally Ramipril (ACE inhibitor) is given first if you don't tolerate it well or have side effects they may switch to Losartan (angiotensin receptor blocking drug) as this is a different type of drug that has very similar effects but can have less side effects
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They will focus more on the reading that is high, while it seems from your reading that perhaps your diastolic reading is controlled however that is down to your care team to determine as they have the info!
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Some interesting discussion points here, and many that I don't think science can give a definitive answer on. It is important to consider that stress is a known contributor to cardiovascular problems and is likely to be multi-factorial involving various hormones, the autonomic and central nervous systems. Interestingly many of the stress hormones have actions...
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I think in this case it is more the risk benefit for beta blockers vs ACEi or calcium blockers, beta blockers have a higher risk of serious adverse effects and less evidence of reducing mortality and morbidity in hypertension. The are however still used as "first line" drugs in angina and numerous other cardiovascular diseases where evidence for clinical...
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Beta blockers are generally in step 4. Theyused to be in step 1 and 2 but triasl showed that while there use at early stages was effective at lowering BP they did not have clinical benefits better than ACE inhibitors or Calcium channel blockers and there were complications and side effects in their use. For certain patients they may replace ACE inhibitors....
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Anti-hypertensive drugs are highly unlikely to be given without a confirmed diagnosis of hypertension, the strategy is to reduce BP quickly as it is known, proven risk factor for CV complications and research shows treatment works. So while some people may benefit from lifestyle changes and this may take them out of the hypertensive range everyone who has...
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It is in the extra information, but essentially by losing the fluid, normally in the form of urine and this is a role of the kidneys and why kidney diseases are is strongly associated with high blood pressure.
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Thank you all for the lovely comments and sharing your experiences of cardiovascular disease with us. It is true that genetics plays a huge role in cardiovascular disease but it is important to realise that often this increases risk it does not necessarily mean you will also suffer, environmental factors play a huge role as you will find out this week! Its...
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This is a beginners course and while the action of the drug is quite simple (blocks calcium channels) the physiology underlying that action is complicated, it is explained in simple terms on the NHS choices website. Pharmacology is the study of how drugs work in the body (and how they can be used to understand how the body works) perhaps someone will start a...
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In High blood pressure something has gone wrong with one or more of the control mechanisms like the carotid body and the "baroceptor reflex" that it is involved in. As I mention it is not the only control mechanism and these mechanisms are linked; so if one goes wrong it can impact on other control mechanisms and the body does not respond appropriately to the...
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It is a risk factor so if you smoke you are more likely to develop high blood pressure, risk factors will be covered next week.
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It is possible to have high cholesterol and normal blood pressure (and vice versa) these risk factors may often present together. in most patients (90-95% ) the exact cause of high blood pressure is unknown and arises from multiple often unknown factors; this is often referred to as primary (or essential) hypertension. What we can say is that high cholesterol...
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Well noticed! This information is included in the additional information file associated with the video, I felt that a detailed description may have been confusing in the introductory video as kidney function is not covered in this course
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Alister McNeish (educator) made a comment
Again some really interesting debate going on here, I am really pleased that many of you want to learn more about how the drugs work and why certain patient groups are given certain drugs. I think both those topics are beyond a beginners course. However, the NHS choices website is a good starting point to find more out about the drugs themselves.
The... -
Just to add to Alexander's answer for ACE inhibitors: Angiotensin II also constricts blood vessels to increase blood pressure, so by preventing its production they also indirectly relax blood vessels as this constriction cannot then occur.
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There is a glossary of terms and extra information if that helps
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Position does affect blood pressure, as does the time of day and activities you have been doing that's why you would not be diagnosed with hypertension from a single measurement. Healthcare professionals tend to take repeated measurements in the same conditions or preferably over a period of time using ambulatory blood pressure monitoring (in the latter case...
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Alister McNeish (educator) made a comment
Nice to see some interesting debate on here! I think the message about heart disease with diet and exercise are important; along with smoking these are probably the easiest to modify risk factors. This module is about cardiovascular disease but it is important to realise that even someone with very high non-modifiable risk factors can reduce their risk of...
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Alister McNeish (educator) made a comment
I have recently discovered that i am not a fine details person when it comes to project/person management (which I would have assumed to be the case as I concentrate on details in my research). I was frustrated with people asking about little details I found irrelevant. My eureka moment was that I need not be frustrated and instead embrace these people around...
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Would be interesting to see if wine affected your blood pressure, if your blood pressure drops you would expect the baroceptor reflex I described to increase your HR in order to maintain BP - could be an interesting home experiment!
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Spot on James, the research on red wine has been called into question, it would appear that it may have a positive effect in a small subsection of the population (strongest evidence for a glass a day or so for middle aged men - not the whole population). Although I am not sure everyone would have your reaction to red wine, these studies are based on average...
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We have to think of short versus long term effects, drinking large volumes is going to have potential effects on BP and the kidneys if it is alcohol or not. Chronic drinking is going to have lots of different effects on the body. Alcohol affects the function of most organs and will have complex effects. In truth we know very little about the complex...
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Alister McNeish (educator) made a comment
I would just like to thank everyone for there lovely comments I thought it was easier to just put a message here than thank everyone individually. I think passion is is important in no matter what you do!
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I always like to say its the most important science you have never heard of! Yes it can be confusing as you have to use knowledge from lots of different branches of science.
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Blood pressure goes up during pregnancy (the classification of hypertension in pregnancy is different as some raise in BP is expected) some women need treatment for this "gestational hypertension" and thus only during the pregnancy as blood pressure normally returns to normal afterwards.
Often being given medication for hypertension means you need to take...
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These factors are considered too, hypertension however is the major risk factor for other cardiovascular diseases and the strategy is to lower it as quickly as possible - this normally means drugs, at least in the short term.
In your example if you had all these good lifestyle habits and still had hypertension then you would still be at increased risk of...
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Mamuka, its not that they are less effective than they used to be, its that evidence shows that the other drugs e.g. ACE inhibitors and calcium channel blockers are more effective/better tolerated as 1st line medications.
Treatment strategies often change based on new evidence for example beta blockers were one of the 1st line treatments for hypertension...
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Lifestyle changes will reduce risk and may even improve health, however some things such as your genetic background, sex, and age cannot be changed. Also even if you have perfect lifestyle you may just be unlucky and develop hypertension thus a clinical intervention such as medication would be required. Clearly if you have had a bad lifestyle some damage may...
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As Dafni says, yes BP is affected by hormones, and BP normally raises during pregnancy and normally returns to normal afterwards. it is impossible to speculate as to why yours remained high.... many factors could be involved it is unlikely that the doctors would be able to pinpoint an individual cause following the pregnancy.
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Hi Elizabeth, thanks for your story, I was also bought up in fife in Kirkcaldy!
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Thanks Laurence, kidney function is very important for blood pressure and its regulation i did not discuss it here for simplicity. I think i would have needed another couple of videos to cover the kidney! Perhaps there will be another MOOC on future learn about the kidney?
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As this was a beginners guide I did not want to throw drug names at people as it can be very confusing, as Natasha says search on the internet and share here! If you do take medication for hypertension you can read the information leaflet in the packaging which will also explain what it is, hopefully that will make sense now! Asking a pharmacist is also a good...
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Your Genetic background will predispose you to some diseases and can also mean that you respond to some medications differently. Where large numbers of people receive treatment for disease over time researchers begin to see what seems to work best on different sub populations such as the elderly, the young and people form different ethnic backgrounds. Clinical...
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Angitnensin II receptor antagonists are interchangeable with ACE inhibitors on the ACD chart and clinically have much the same effect. ACE inhibitors prevent angiotensin II being produced, angiotensin II receptor antagonists "block" the effect of angiotensin II. Most people will be given an ACE inhibitor first, they are safe, tolerated by most people, have...
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I would advice this is a good place to look if you are really interested and covers many of the gaps I cannot possibly cover in a short video, the American heart Association and British Heart Foundation also have excellent guides.
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Insightful Brian, arteries contract (blood pressure goes up) the heart beat more slowly in an effort to help reduce the blood pressure back to normal (reducing cardiac output), if arteries dilate (diameter increases) blood pressure goes down, but more blood is returned to the heart, so it beats more quickly. In fact a side effect of some (particularly older...
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There are difference in all people regardless of ethnicity, however in general if we look at population groups people from some ethnic backgrounds do have higher risks for hypertension and respond differently to medications. In fact individualising health care (personalized medicine) based on your background, lifestyle response to medications has been a major...
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I see Michael has beaten me to this I would almost always refer people to the NHS website for further information on these kind of stories in newspapers. The NHS site breaks it down in a simple way without the editorial slant of a newspaper. John I would say a problem with any part of the bodies control mechanisms for blood pressure (and there are many!) may...
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Ageing is THE most common risk factor regardless of other risk factors - it is not to blame! Clearly poor lifestyle contributes, the difference is lifestyle factors are modifiable - ageing is not. We would advice everyone to make lifestyle changes to minimise risk.
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Elite athletes and very fit people often have heart rates as low as in the 30's, however a low heart rate can indicate a cardiovascular problem and even though there is a wide variation in population of "normal" if your heart rate is consistently low or getting lower with no obvious explanation it is something worth discussing with your GP - especially if you...
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Watch the next video in the gym? :)
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Some people will be given home monitoring kits for blood pressure and often people who have had cardiovascular events will have their ECG closely monitored to check for any changes. As Michael says all people will have variations in ECG and blood pressure which may cause alarm but may not actually indicate a condition; false alarms cause stress and use up...
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Gabrielle, yes in a "closed system" like a central heating system increasing fluid would increase the pressure, the same is true for the body. However the body can control this as the kidneys will detect this increase in volume and remove the excess water (as dilute urine low in salts). Similarly when the body is dehydrated the kidneys preserve water and less...
