Two out of three people over 65 take treatment to lower blood pressure (BP) to prevent heart attacks and strokes. BP treatment also increases the chance of having a fall if blood pressure is lowered too much. As people get older, their BP tends to rise and fall more dramatically. All this makes it hard to know how to prescribe BP treatment in later life. The best way to measure BP is for a patient to wear a BP machine which records BP two to three times an hour for 24 hours. This is called Ambulatory Blood Pressure (ABP). The machine calculates the middle (average) BP reading, and how much the readings change over 24 hours. Both measures predict heart attacks and strokes, and so help us to know whether to start BP treatment. We do not know if these measures also predict falls and so can show us whether to reduce or stop BP treatment in older people.
Background
Aims & Objectives
This research question is whether ABP measures can inform shared treatment decisions in high blood pressure (hypertension) for older adults who are at risk of falls.
Methods
Dr Oliver Todd will answer this question in two studies.
Study 1 has three phases:
In Phase 1, Dr Todd will build three databases using data previously collected from people living in Bradford, Edinburgh and Liverpool. In 2022 he developed software to link ABP records of 14,675 people in Bradford to their GP, hospital, and council data which includes information on falls, heart attacks, strokes and deaths. Personal details were removed to protect people’s privacy. He will use this software to do the same for people in Edinburgh and Liverpool, and use all three databases for Phases 2 and 3.
In Phase 2, Dr Oliver Todd will find out if ABP measures predict falls, as well as heart attacks, strokes and deaths. This will help understand results of ABP for older adults with hypertension who are already at risk of falls.
In Phase 3, he will explore if older adults who had their BP treatment changed after ABP went on to have fewer falls, heart attacks, strokes and deaths. These results will guide how to make choices about BP treatment as safely as possible.
Study 2
With the help of patients, patient family members and carers, doctors, nurses, pharmacists and technicians, Dr Oliver Todd will create easy to use guides about how to make choices about BP treatment in older adults who are at risk of falls. This will help older adults take part in choices about their BP treatment.
This research will improve the safety of BP treatment in older adults at risk of falls and make it easier for patients to be involved in decisions about their treatment. The databases to be built will be the largest and most detailed of their kind worldwide and help understand hypertension in old age.
Partners & Collaborators
Investigator:
Dr Oliver Todd
Contracting Organisation:
University of Leeds
Further information
Funding acknowledgement and disclaimer (where applicable)
This study is funded by the National Institute for Health and Care Research Advanced Fellowship
Contact details: