Dr W. E. Miall

Epidemiologist who investigated hypertension
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The Independent Online

W. E. Miall was a pioneer in research on blood pressure. Largely as a result of Professor George Pickering's influence at St Mary's Hospital, Paddington, in London in the early 1950s, Miall carried out a series of population-based studies in South Wales and Jamaica, which confirmed the unimodal distribution of blood pressure, and showed the graded relationship between pressure and the risk of cardiovascular disease.

William Einar Miall, epidemiologist: born Selly Oak, Warwickshire 10 October 1917; Epidemiologist, Medical Research Council Pneumoconiosis Research Unit, Llandough 1952-62; Director, Epidemiological Research Unit, Jamaica 1962-71; scientific staff, MRC Epidemiology and Medical Care Unit, Northwick Park Hospital and Secretary, MRC Working Party on the Mild Hypertension Trials 1971-83; married 1948 Mary Scott (died 2000; four sons, one daughter); died Staveley, Cumbria 5 June 2004.

W. E. Miall was a pioneer in research on blood pressure. Largely as a result of Professor George Pickering's influence at St Mary's Hospital, Paddington, in London in the early 1950s, Miall carried out a series of population-based studies in South Wales and Jamaica, which confirmed the unimodal distribution of blood pressure, and showed the graded relationship between pressure and the risk of cardiovascular disease.

His work culminated in the Medical Research Council's two hypertension trials in the 1970s and 1980s, using several hundred GP practices, which led to the establishment of the General Practice Research Framework.

Bill Miall was born in 1917 in Selly Oak, near Birmingham, into a Quaker family with roots in Yorkshire. In 1939 he registered as a conscientious objector, joined the Friends Ambulance Unit and served in Norway, Finland and Greece. He was captured in Greece and transferred to a transit camp in Salonika, where he met Archie Cochrane, one of the legendary figures in the development of randomised controlled trials that were to play such a large part in his later work. When Miall was repatriated in 1944 he entered St Mary's Hospital Medical School, qualifying in 1950, and became George (later Sir George) Pickering's house physician.

This was at the time that Pickering's view that blood pressure follows a single, unimodal distribution was becoming accepted over Sir Robert Platt's view of two separate distributions. But both Pickering and Platt had worked on hospital patients who were often selected for reasons to do with their blood pressures.

Miall realised that unselected, free-living population groups would need to be studied. This led him to join the MRC Pneumoconiosis Research Unit in South Wales, where he renewed his association with Cochrane. Here, he organised meticulous surveys of the mining communities in the Rhondda Fach. This work, with the statistician Peter Oldham, confirmed Pickering's view and showed that there is a graded relationship between pressure and the risk of stroke and heart attack.

In 1962 Miall was appointed Director of the Medical Research Council's Epidemiological Research Unit in Jamaica, where he continued his work on blood pressure and, with Professor Ed Kass, on the role of urinary infection on blood pressure. In 1971 he joined Tom Meade in the MRC Epidemiology and Medical Care Unit at Northwick Park Hospital in Harrow, Middlesex.

Until the 1950s or 1960s, there were very few acceptable treatments for significant hypertension. In the late 1960s, small trials in the United States had shown that agents with fewer side effects than those previously available undoubtedly reduced strokes and other complications in patients with serious or moderate hypertension. Would it be worthwhile to detect those with "mild hypertension" and to treat them with the better tolerated agents that were by then available?

Prompted by Colin Dollery, then Professor of Clinical Pharmacology at the Royal Postgraduate Medical School, the MRC set up a working party under Stan Peart's chairmanship, of which Miall's old colleagues Geoff Rose, Tony Lever, Mike Hamilton and Archie Cochrane were also members, Miall himself becoming the scientific secretary. A trial on mild hypertension had to be large. Eventually, a proposal went forward to the MRC where it was agreed that a trial in 18,000 participants should go ahead.

How were many thousands of healthy participants to be recruited? Strange as it now seems, the idea of using general practices to recruit patients was almost an afterthought, though in fact it proved very effective. The first hypertension trial was carried out in 176 general practices in people aged between 35 and 64; a second trial in older people needed 226 practices. The main results were published in the British Medical Journal in 1985 and 1992 respectively. Taken together, the two trials showed a considerable reduction in strokes due to treatment and a smaller, less certain, reduction in heart attacks.

Miall's immense contributions were, first, in recruiting the general practices, ensuring their standards, bringing many nurses into research through their training and supervision by Greta Barnes, and, day by day, personally checking the numerous entry and follow-up records and heart tracings involved. Secondly, the general practices in the hypertension trials formed the beginning of the MRC's General Practice Research Framework, now one of the jewels in the Council's crown, and consisting of over 1,000 practices throughout the United Kingdom responsible for research on a wide variety of topics.

Bill Miall continued his interests in hypertension and its management after retirement. An MRC grant enabled him to write a book with Gillian Greenberg about the first MRC trial, published in 1987, Mild Hypertension: is there pressure to treat?

He retired to the Lake District where he continued as an enthusiastic oil painter and took up sculpture, the wood near his house becoming a family sculpture park. In 1997, Miall underwent surgery for colon cancer, about which one of his family concluded that "a semi-colon is better than a full stop".

Tom Meade and Stan Peart

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