Rupert Payne

Bio: Rupert Payne is an academic researcher from University of Bristol. The author has contributed to research in topics: Polypharmacy & Medicine. The author has an hindex of 23, co-authored 107 publications receiving 2741 citations. Previous affiliations of Rupert Payne include Queen's University & University of Cambridge.

Pulse transit time measured from the ECG: an unreliable marker of beat-to-beat blood pressure

Abstract: The arterial pulse-wave transit time can be measured between the ECG R-wave and the finger pulse (rPTT), and has been shown previously to have a linear correlation with blood pressure (BP). We hypo...

The epidemiology of multimorbidity in primary care: a retrospective cohort study

Abstract: Background Multimorbidity places a substantial burden on patients and the healthcare system, but few contemporary epidemiological data are available. Aim To describe the epidemiology of multimorbidity in adults in England, and quantify associations between multimorbidity and health service utilisation. Design and setting Retrospective cohort study, undertaken in England. Method The study used a random sample of 403 985 adult patients (aged ≥18 years), who were registered with a general practice on 1 January 2012 and included in the Clinical Practice Research Datalink. Multimorbidity was defined as having two or more of 36 long-term conditions recorded in patients’ medical records, and associations between multimorbidity and health service utilisation (GP consultations, prescriptions, and hospitalisations) over 4 years were quantified. Results In total, 27.2% of the patients involved in the study had multimorbidity. The most prevalent conditions were hypertension (18.2%), depression or anxiety (10.3%), and chronic pain (10.1%). The prevalence of multimorbidity was higher in females than males (30.0% versus 24.4% respectively) and among those with lower socioeconomic status (30.0% in the quintile with the greatest levels of deprivation versus 25.8% in that with the lowest). Physical–mental comorbidity constituted a much greater proportion of overall morbidity in both younger patients (18–44 years) and those patients with a lower socioeconomic status. Multimorbidity was strongly associated with health service utilisation. Patients with multimorbidity accounted for 52.9% of GP consultations, 78.7% of prescriptions, and 56.1% of hospital admissions. Conclusion Multimorbidity is common, socially patterned, and associated with increased health service utilisation. These findings support the need to improve the quality and efficiency of health services providing care to patients with multimorbidity at both practice and national level.

Arterial Stiffness and Hypertension. Emerging Concepts

Abstract: Arterial stiffness is increasingly recognized as an important prognostic index and potential therapeutic target in patients with hypertension. It is closely linked to, but by no means synonymous with, raised blood pressure, and its physiopathology is still not fully understood. Aortic stiffness and arterial pulse wave reflections are key determinants of elevated central systolic pressure and are associated with adverse cardiovascular outcomes, independent of blood pressure. Indeed, the 2003 European Society of Hypertension guidelines on the management of hypertension acknowledge the potential role of arterial stiffness measurement in clinical management1 and have prompted the publication of a consensus document on the measurement of central blood pressure and hemodynamics.2 A detailed expert consensus document has also been published on the methodologic and clinical issues around arterial stiffness.3 Broader implementation of these techniques into routine care seems inevitable. In this review, we have examined recent research in this field published in Hypertension , focusing on mechanistic work, methods for measuring stiffness, important clinical associations, and effects of treatment. ### Mechanisms and Causes of Arterial Stiffness Hypertension and arterial stiffness are closely associated with age.4 Degeneration of compliant elastin fibers, and deposition of stiffer collagen, is considered a key cause of age-related arterial stiffening. Moreover, blood pressure plays a significant role in determining vessel wall structure, with remodeling occurring to compensate for changes in wall stress. One potential mechanism is through matrix metalloproteinases, which modulate extracellular matrix proteins. When angiotensin II is given to mice, matrix metalloproteinase 9 activity is induced, resulting in enhanced collagen degradation. This improves the intrinsic distensibility of elastic arteries and, thus, blunts any blood pressure rise.5 Impairment of this compensatory mechanism may, therefore, contribute to increased stiffness. The organization of elastic fibers is also important. Inhibition of the vascular adhesion protein semicarbazide-sensitive amine oxidase in a rat model results in …

UK indices of multiple deprivation - a way to make comparisons across constituent countries easier

Abstract: Background Deprivation is multi-dimensional, and as such can be challenging to quantify. In the UK, each of the four constituent countries measures deprivation using their own distinct index of multiple deprivation (IMD), designed to facilitate targeting of policies within that particular country. Although these four IMD scores are not directly comparable, there are circumstances where comparison across the whole of the UK may be desirable. Methods A method of generating a UK-wide IMD score was developed using publically available data. An adjusted IMD score was generated using the employment and income domains of the individual country IMD scores, along with the coefficients and residual values from a linear regression of employment and income on the overall IMD score. Results The Scottish IMD was used as a baseline to generate an adjusted UK-wide score. The proportion of variance explained for the Scotland model was 0.972. The rank correlation coefficient (Kendall’s tau) for the association between adjusted and original IMD was 0.97, 0.98 and 0.94 for England, Northern Ireland and Wales respectively. The absolute change in Welsh and English IMD scores

The effect of physical multimorbidity, mental health conditions and socioeconomic deprivation on unplanned admissions to hospital: a retrospective cohort study

Abstract: Background: Multimorbidity, the presence of more than 1 long-term disorder, is associated with increased use of health services, but unplanned admissions to hospital may often be undesirable. Furthermore, socioeconomic deprivation and mental health comorbidity may lead to additional unplanned admissions. We examined the association between unplanned admission to hospital and physical multimorbidity, mental health and socioeconomic deprivation. Methods: We conducted a retrospective cohort study using data from 180 815 patients aged 20 years and older who were registered with 40 general practices in Scotland. Details of 32 physical and 8 mental health morbidities were extracted from the patients’ electronic health records (as of Apr. 1, 2006) and linked to hospital admission data. We then recorded the occurrence of unplanned or potentially preventable unplanned acute (nonpsychiatric) admissions to hospital in the subsequent 12 months. We used logistic regression models, adjusting for age and sex, to determine associations between unplanned or potentially preventable unplanned admissions to hospital and physical multimorbidity, mental health and socioeconomic deprivation. Results: We identified 10 828 (6.0%) patients who had at least 1 unplanned admission to hospital and 2037 (1.1%) patients who had at least 1 potentially preventable unplanned admission to hospital. Both unplanned and potentially preventable unplanned admissions were independently associated with increasing physical multimorbidity (for ≥ 4 v. 0 conditions, odds ratio [OR] 5.87 [95% confidence interval (CI) 5.45–6.32] for unplanned admissions, OR 14.38 [95% CI 11.87–17.43] for potentially preventable unplanned admissions), mental health conditions (for ≥ 1 v. 0 conditions, OR 2.01 [95% CI 1.92–2.09] for unplanned admissions, OR 1.80 [95% CI 1.64–1.97] for potentially preventable unplanned admissions) and socioeconomic deprivation (for most v. least deprived quintile, OR 1.56 [95% CI 1.43–1.70] for unplanned admissions, OR 1.98 [95% CI 1.63–2.41] for potentially preventable unplanned admissions). Interpretation: Physical multimorbidity was strongly associated with unplanned admission to hospital, including admissions that were potentially preventable. The risk of admission to hospital was exacerbated by the coexistence of mental health conditions and socioeconomic deprivation.

Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury

Abstract: Acute kidney injury (AKI) is a complex disorder for which currently there is no accepted definition. Having a uniform standard for diagnosing and classifying AKI would enhance our ability to manage these patients. Future clinical and translational research in AKI will require collaborative networks of investigators drawn from various disciplines, dissemination of information via multidisciplinary joint conferences and publications, and improved translation of knowledge from pre-clinical research. We describe an initiative to develop uniform standards for defining and classifying AKI and to establish a forum for multidisciplinary interaction to improve care for patients with or at risk for AKI. Members representing key societies in critical care and nephrology along with additional experts in adult and pediatric AKI participated in a two day conference in Amsterdam, The Netherlands, in September 2005 and were assigned to one of three workgroups. Each group's discussions formed the basis for draft recommendations that were later refined and improved during discussion with the larger group. Dissenting opinions were also noted. The final draft recommendations were circulated to all participants and subsequently agreed upon as the consensus recommendations for this report. Participating societies endorsed the recommendations and agreed to help disseminate the results. The term AKI is proposed to represent the entire spectrum of acute renal failure. Diagnostic criteria for AKI are proposed based on acute alterations in serum creatinine or urine output. A staging system for AKI which reflects quantitative changes in serum creatinine and urine output has been developed. We describe the formation of a multidisciplinary collaborative network focused on AKI. We have proposed uniform standards for diagnosing and classifying AKI which will need to be validated in future studies. The Acute Kidney Injury Network offers a mechanism for proceeding with efforts to improve patient outcomes.

Photoplethysmography and its application in clinical physiological measurement.

Abstract: Photoplethysmography (PPG) is a simple and low-cost optical technique that can be used to detect blood volume changes in the microvascular bed of tissue. It is often used non-invasively to make measurements at the skin surface. The PPG waveform comprises a pulsatile ('AC') physiological waveform attributed to cardiac synchronous changes in the blood volume with each heart beat, and is superimposed on a slowly varying ('DC') baseline with various lower frequency components attributed to respiration, sympathetic nervous system activity and thermoregulation. Although the origins of the components of the PPG signal are not fully understood, it is generally accepted that they can provide valuable information about the cardiovascular system. There has been a resurgence of interest in the technique in recent years, driven by the demand for low cost, simple and portable technology for the primary care and community based clinical settings, the wide availability of low cost and small semiconductor components, and the advancement of computer-based pulse wave analysis techniques. The PPG technology has been used in a wide range of commercially available medical devices for measuring oxygen saturation, blood pressure and cardiac output, assessing autonomic function and also detecting peripheral vascular disease. The introductory sections of the topical review describe the basic principle of operation and interaction of light with tissue, early and recent history of PPG, instrumentation, measurement protocol, and pulse wave analysis. The review then focuses on the applications of PPG in clinical physiological measurements, including clinical physiological monitoring, vascular assessment and autonomic function.

Recommendations for Improving and Standardizing Vascular Research on Arterial Stiffness: A Scientific Statement From the American Heart Association

Abstract: Much has been published in the past 20 years on the use of measurements of arterial stiffness in animal and human research studies. This summary statement was commissioned by the American Heart Association to address issues concerning the nomenclature, methodologies, utility, limitations, and gaps in knowledge in this rapidly evolving field. The following represents an executive version of the larger online-only Data Supplement and is intended to give the reader a sense of why arterial stiffness is important, how it is measured, the situations in which it has been useful, its limitations, and questions that remain to be addressed in this field. Throughout the document, pulse-wave velocity (PWV; measured in meters per second) and variations such as carotid-femoral PWV (cfPWV; measured in meters per second) are used. PWV without modification is used in the general sense of arterial stiffness. The addition of lowercase modifiers such as “cf” is used when speaking of specific segments of the arterial circulation. The ability to measure arterial stiffness has been present for many years, but the measurement was invasive in the early times. The improvement in technologies to enable repeated, minimal-risk, reproducible measures of this aspect of circulatory physiology led to its incorporation into longitudinal cohort studies spanning a variety of clinical populations, including those at extreme cardiovascular risk (patients on dialysis), those with comorbidities such as diabetes mellitus (DM) and hypertension, healthy elders, and general populations. In the ≈3 decades of clinical use of PWV measures in humans, we have learned much about the importance of this parameter. PWV has proven to have independent predictive utility when evaluated in conjunction with standard risk factors for death and cardiovascular disease (CVD). However, the field of arterial stiffness investigation, which has exploded over the past 20 years, has proliferated without logistical guidance for clinical and …