Title: Stratified hypertension management in later life: establishment of cohort linkage between ambulatory blood pressure measurements and routine health and social care data in Connected Bradford
Funder: The Academy of Medical Sciences

Abstract: Background Hypertension increases cardiovascular risk. Blood pressure (BP) lowering can reduce this risk but can also cause adverse effects including falls and fractures which can have disabling consequences for patients. Office BP readings are unreliable in older adults whereas ambulatory BP measurement can capture: -BP variability, which increases with age; -diurnal variation, particularly important for older people who may be at risk of low BP at particular times of day; and, -falsely raised BP in an office setting (white coat hypertension). UK hypertension guidelines already recommend measuring ambulatory BP for diagnosis of hypertension, but not at follow-up. Yet developing frailty and multi-morbidity over time, and the related issue of taking multiple medications, is likely to change a person's ambulatory BP profile during the intervening years since diagnosis. Ambulatory BP at follow up could help better target treatment for older adults. Aim Investigate whether ambulatory BP can provide useful information to inform stratified BP management for older adults. To undertake this work using definitive methods will require observational work in a study population with external validity to routine clinical care, informed by literature review and consultation with patients. Objectives 1. Establish the largest international, high-quality ambulatory BP Cohort Study with linkage of ambulatory BP individual patient data to patient's primary, secondary and social care data through follow up. 2. In this new ambulatory BP Cohort Study to: a) describe the study population; and, b) investigate whether measures of ambulatory BP variability and diurnal variation predict future falls risk.

Lay abstract: More than two thirds of adults will have developed hypertension (high blood pressure) by the age of 60 years old. We know that treatment to lower blood pressure can reduce that person’s future risk of developing a stroke or heart attack. However, we also know that treatment to lower blood pressure can cause people to fall and that older people are particularly vulnerable to injury from falls. We are seeking to develop a more personalised approach to hypertension treatment which could minimise the risk of falls and maximise the benefit of treatment according to the individual’s circumstances. Patients are sometimes given a blood pressure monitor to take home and wear through one day and the following night. This type of reading is called an ambulatory blood pressure monitor because you wear it whilst you walk around and undertake your normal daily tasks. These recordings are becoming easier to do with improvements in technology. These recordings hold a huge amount of information about a person’s blood pressure in their daily life. However, there is a lack of research determining what in an ambulatory blood pressure reading could be useful to inform treatment options. This study will look at 14,675 ambulatory blood pressure records and follow-up the patients to see which ambulatory blood pressure measurements predict good and bad outcomes for those people. We then plan to design hypertension treatment strategies for future patients that are more personalised using the information from these readings alongside other information from a person’s medical record.

Research activity codes: 2.4 SURVEILLANCE AND DISTRIBUTION
Health categories: CARDIOVASCULAR