Terry Mccormack

Hull York Medical School · Institute of Clincial and Applied Health Research

Patients with hypertensive emergencies, malignant hypertension and acute severe hypertension are managed heterogeneously in clinical practice. Initiating anti-hypertensive therapy and setting BP goal in acute settings requires important considerations which differ slightly across various diagnoses and clinical contexts. This position paper by Briti...

Background Allopurinol is a urate-lowering therapy used to treat patients with gout. Previous studies have shown that allopurinol has positive effects on several cardiovascular parameters. The ALL-HEART study aimed to determine whether allopurinol therapy improves major cardiovascular outcomes in patients with ischaemic heart disease. Methods ALL-...

Introduction Unmet needs in patients with cancer and their carers are common but poorly identified and addressed. The Needs Assessment Tool-Cancer (NAT-C) is a structured consultation guide to identify and triage patient and carer unmet needs. The NAT-C is validated, but its effectiveness in reducing unmet patient and carer needs in primary care is...

In this article, the name of the GLORIA-AF investigator Anastasios Kollias was given incorrectly as Athanasios Kollias in the Acknowledgements. The original article has been corrected.

Introduction Emerging research suggests that statin use for primary prevention in people without diabetes aged 75 and older has no benefit. This study aims to determine the feasibility of the theoretical Stop Statin Study (3S), a double-blind randomised controlled trial carried out in general practice, which would test this hypothesis. 50% of trial...

Introduction There is conflicting evidence on the benefit of statins for primary prevention of cardiovascular disease (CVD) in non-diabetics over 75. Emerging evidence shows they may be ineffective, yet current guidance supports their use in those up to 85. The objectives of this study were to assess patients’ understanding of statins, willingness...

We describe two cases of Takotsubo syndrome and discuss the issues relating to diagnosis and patient communication that they raise.

Aim The SAMe-TT2R2 score helps identify patients with atrial fibrillation (AF) likely to have poor anticoagulation control during anticoagulation with vitamin K antagonists (VKA), and those with scores >2 might be better managed with a target-specific oral anticoagulant (NOAC). We hypothesized that in clinical practice, VKAs may be prescribed less...

Patients with uncontrolled hypertension are at increased risk of complications during general anaesthesia but the number of patients whose surgery is delayed or cancelled due to hypertension remains unknown. Prospective, regional multicentre service evaluations were performed on consecutive patients undergoing elective surgery before and after the...

Familial hypercholesterolaemia (FH) is the most common monogenic lipid metabolism disorder, affecting up to 1 in 250 people in the UK. Patients with FH have high levels of low‐density lipoprotein cholesterol and are at very high risk of premature cardiovascular disease. This article focuses on the clinical aspects of FH to help primary care profess...

Bevacizumab is an anti-vascular endothelial growth factor monoclonal antibody that may prolong survival in ovarian and cervical cancer when given in combination with chemotherapy. It works by blocking the signalling pathways that are required for tumour angiogenesis, potentially limiting the cancer’s ability to grow and spread. Hypertension is a kn...

An Audit of three trusts in the Hull York Medical School region following recent guidelines released by the British and Irish Hypertension Society in collaboration with the Association of Anaesthetists of Great Britain and Ireland.

Introduction: Poor adherence to acne treatment may lead to unnecessary treatments, increased healthcare costs, and reduced quality of life (QoL). This multicenter study evaluated the effect of supplementary patient education material (SEM) (a short video, information card, and additional information available online) on treatment adherence and sat...

Background: GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non-vitamin K ant...

Background: Cardiovascular disease (CVD) is the leading cause of death in Europe and increased low-density lipoprotein cholesterol (LDL-C) is a major contributor to CVD risk. Extensive evidence from clinical studies of statins has demonstrated a linear relationship between LDL-C levels and CVD risk. It has been proposed that lower LDL-C levels tha...

The British Hypertension Society (BHS) and the Association of Anaesthetists of Great Britain and Ireland (AAGBI) have published a joint guideline, ‘The measurement of adult blood pressure and management of hypertension before elective surgery’ in the journal Anaesthesia .1 Very few, if any, GPs read this journal, hence the need for a coordinated pu...

This guideline aims to ensure that patients admitted to hospital for elective surgery are known to have blood pressures below 160 mmHg systolic and 100 mmHg diastolic in primary care. The objective for primary care is to fulfil this criterion before referral to secondary care for elective surgery. The objective for secondary care is to avoid spurio...

This is a summary of a pre-operative blood pressure measurement and management guideline intended for use in the United Kingdom and Ireland. It is a joint guideline by the Association of Anaesthetists of Great Britain and Ireland (AAGBI) and the British Hypertension Society. A working party was formed comprising of four members of each society. A S...

Background: The results of the Hypertension in the Very Elderly Trial showed positive benefits from blood pressure-lowering treatment in those aged 80 and over. Method: An analysis by the pre-specified subgroups [age, sex, history of cardiovascular disease (CVD) and initial SBP] was performed. The Hypertension in the Very Elderly Trial was a ran...

Importance In phase 2 studies, evolocumab, a fully human monoclonal antibody to PCSK9, reduced LDL-C levels in patients receiving statin therapy. Objective To evaluate the efficacy and tolerability of evolocumab when used in combination with a moderate- vs high-intensity statin. Design, Setting, and Patients Phase 3, 12-week, randomized, double-b...

Although the number of individuals reaching 80 who are considered to be healthy is increasing, the very elderly are likely to have long-term conditions, to report symptoms and/or be taking at least one regular medication. The impact of antihypertensive treatment has to be taken into account in this context. The treatment regimen in Hypertension in...

With the arrival of the newer oral anticoagulants (NOACs), we now have a more convenient means of providing anticoagulation for patients with non-valvular atrial fibrillation (AF). Are there any particular considerations for the many patients who also have coronary artery disease? For many patients there is an obvious need to use the newer agents b...

Hypertension is common and is one of the leading causes of cardiovascular events such as stroke and ischaemic heart disease. It is responsible for approximately 12% of consultations in primary care. This is a summary of the key points in the 2011 National Institute for Health and Clinical Excellence (NICE) hypertension guideline.1 This is an update...

To assess if very elderly people with hypertension obtain early benefit from antihypertensive treatment. One year open label active treatment extension of randomised controlled trial (Hypertension in the Very Elderly Trial (HYVET)). Hospital and general practice based centres mainly in eastern and western Europe, China, and Tunisia. People on doubl...

Hypertension is one of the most important preventable causes of death worldwide and one of the commonest conditions treated in primary care in the United Kingdom, where it affects more than a quarter of all adults and over half of those over the age of 65 years.1 This article summarises the most recent recommendations from the National Institute fo...

Apolipoprotein B (ApoB) is a superior predictor of low-density-lipoprotein (LDL) particle number and cardiovascular disease (CVD) risk compared with LDL-cholesterol (LDL-C) levels. Current evidence has shown a degree of discordance between LDL-C with ApoB levels among patients not receiving lipid-lowering therapy. The extent of this discordance amo...

The prevalence and burden of cardiovascular disease (CVD) is high, and it remains the leading cause of death worldwide. Unfortunately, many individuals who are at high risk for CVD are not recognized and/or treated. Therefore, programs are available to ensure individuals at risk for CVD are identified through appropriate risk classification and off...

It has long been an accepted belief that serum cholesterol significantly falls after myocardial infarction and that a return to pre-event levels takes approximately 3 months. The magnitude and clinical significance of this fall has recently been challenged. In the Secondary Prevention of Acute Coronary Events-Reduction Of Cholesterol to Key Europea...

Aim: The aim of this study was to compare ezetimibe/simvastatin combination therapy with intensified statin monotherapy as alternative treatment strategies to achieve the Joint British Societies (JBS)-2 and National Institute for Health and Clinical Excellence low-density-lipoprotein cholesterol (LDL-C) target of < 2 mmol/l for secondary prevention...

depression is common in elderly people and may be associated with increased cardiovascular risk and incident dementia. participants in the Hypertension in the Very Elderly Trial (HYVET) completed a depression screening instrument, the Geriatric Depression Score (GDS), at baseline and annually. We examined the association of GDS score with incident...

Pharmacogenetics aims to maximize benefits and minimize risks of drug treatment. Our objectives were to examine the influence of common variants of hepatic metabolism and transporter genes on the lipid-lowering response to statin therapy. The Genetic Effects On STATins (GEOSTAT-1) Study was a genetic substudy of Secondary Prevention of Acute Corona...

We sought to evaluate reports that rosuvastatin 10 mg is a more efficacious treatment of hyperlipidaemia than is simvastatin 40 mg, hoping to assess this issue in the previously unstudied context of acute myocardial infarction. The Secondary Prevention of Acute Coronary Events - Reduction of Cholesterol to Key European Targets (SPACE ROCKET) Trial...

In 2006, 78% of patients with coronary heart disease (CHD) achieved the National Quality and Outcomes Framework (QOF) of the General Medical Services (GMS) target of 5.0 mmol/L for total cholesterol. This is a significant achievement in secondary prevention and shows that the standard of care in the UK is becoming aligned with that of the rest of E...

If I were to suffer a stroke, my first requirements would be that it is quickly diagnosed and rapid transport to hospital provided. I would want good respiratory support throughout and a rapid CT or MRI brain scan. I would hope to be treated both immediately and in the longer term by a dedicated, experienced multidisciplinary stroke team in a speci...

Terry McCormack outlines how a new cholesterol-lowering drug which combines a statin with ezetimibe may help some patients.

A panel of experts, sponsored by Merck Sharp & Dohme Ltd and Schering-Plough Ltd and made up of cardiologists, lipidologists, general practitioners and nurses with a special interest in coronary heart disease and lipid management, met recently to debate whether individuals with hyperlipidaemia are being treated to effective levels and, if not, how...

The new General Medical Services contract has introduced the term 'maximally tolerated blood pressure treatment', which it defines as a cut-off point at which a doctor might advise the patient to accept the current blood pressure level. Whilst this is a sensible idea, the contract does not give any guidance as to how the doctor should decide when t...

A survey on cardiovascular education was sent out to over 1,800 general practitioners by the Primary Care Cardiovascular Society. This generated 304 replies. Of those responding, the majority indicated they would be interested in postgraduate education in cardiovascular medicine. Most would prefer a simple distance-learning course covering the 30 c...

This article looks at the results of four studies which examined the delivery of early thrombolysis by general practitioners and ambulance paramedics to patients suffering an acute myocardial infarction. The studies found that they could provide early thrombolysis safely. One study in an isolated rural area in Scotland found general practitioners w...

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