Tāmaki Innovation Campus


IMPROVING CVD RISK PREDICTION IN PRIMARY CARE GETS HRC FUNDING


Robert Scragg Professor Robert Scragg

Professor Robert Scragg has long-term interest in Vitamin D and the role it could play in blood pressure management. His most recent work has come out of a large vitamin D supplementation trial that included measurement of the pressure waves of blood pumped through our arteries by the heart (arterial pressure waveforms), using a device developed by Kiwi engineers.

The results found that parameters derived from the arterial waveform predict cardiovascular disease (CVD) on top of existing risk factors such as smoking and cholesterol. The results were distinctive enough to warrant further study.

A recent grant from the Health Research Council of $1.99m for   a further four-year study, due to start in October, will see these findings tested in the clinical setting of general practice. It will involve a grouping of engaged GPs, 30,000 participants, along with an experienced research team. There is keen international interest in the study, which could pave the way for improved CVD risk prediction through its novel way of measurement.

Professor Scragg, from the School of Population Health, in the Faculty of Medical and Health Sciences, explains how it all started with a device developed some years ago by a New Zealand company, which subsequently was sold to Australia’s Uscom, who now market the device under the name of ‘BP+’.

“This oscillometric device records blood pressure from a cuff placed in the usual position around the upper arm. It is as easy to use as the electronic blood pressure devices commonly available. The only difference is that the pressure is held a little higher than systolic blood pressure for 10 seconds, and during this time the arterial pressure wave is measured and recorded.”

From the waveform, a number of parameters can be derived including aortic blood pressure, which is the blood pressure in the large blood vessel attached to the heart; information only previously available using invasive cardiac catheterisation.

“In our previous work on Vitamin D research, we used this device on 5,000 participants and the results in CVD risk prediction were interesting. So much so, that we believe it could be a very strong indicator of early CVD risk, saving lives, and, potentially, treatment and hospital costs.”

Professor Scragg, alongside the University of Auckland’s Dr John Sluyter, Dr Matire Harwood and Professor Rod Jackson, will work with ProCare clinical director Dr Allan Moffatt to identify a number of GPs who will evaluate this on 30,000 of their patients over four years.

“Working with ProCare means we can reach a broad range of participants through their GP affiliates.  We are intending to split the participants into Maori, Pacific Island and Asian populations (around 6,000 in each group), in addition to other ethnic groups including European.

“The information collected through GPs who sign up for the 50 or so devices, will be anonymous using processes already in place for other studies,” he says.

As the first study of its kind in the world, it is being watched closely by the international research community including colleagues at the University College London and Imperial College London, who have developed the algorithms to derive         the analytical parameters.

Professor Scragg is quietly confident that new steps in disease management will be possible through the outcome of the research, with this simple GP/patient device able to be used widely in the future.