Clinical trial NCT06337682: Blood Pressure Management in the Care Home Population
Official title: Describing the Management of Hypertension in a UK Care Home Population
Study type: OBSERVATIONAL
Overall status: ACTIVE_NOT_RECRUITING
Conditions: Aging
Hypertension
Keywords: Nursing Home
Residential Home
Deprescribing
Lead sponsor: University of Leeds
Sponsor class: OTHER
Collaborators: name: Bradford Teaching Hospitals NHS Foundation Trust
First posted: 2024-03-29
Enrollment: 3000
Sex: ALL
Minimum age (years): 65
Standard ages: OLDER_ADULT
Observational model: COHORT
Time perspective: RETROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Care home residents in the Bradford metropolitan area. The Bradford population has high levels of deprivation and ethnic diversity; a large proportion of the population identify as Pakistani ethnicity.

Brief summary: The UK care home population is projected to increase significantly over the coming decades. A high proportion of individuals in a care home have multiple long-term conditions and take large amounts of prescribed medication. This means they are routinely excluded from research studies and so there is little evidence on which to base treatment of long-term conditions such as high blood pressure. Furthermore, given that 1 in 4 people admitted into a care home die within 1 year, the benefit of treating high blood pressure to reduce the risk of heart attack or stroke must be balanced with the need to optimise quality of life. The aim of this study is to describe the health and social characteristics of the UK care home population with a particular focus on the management of blood pressure in the population. It is hoped that the findings of this study will help inform future research into the management of chronic conditions in care home residents.

Detailed description: The investigators will use the connected Bradford dataset to examine UK electronic health records to describe the UK care home population and management of hypertension in this population. The sample will include all adults aged 65 and over who have been admitted into a care home between January 2016 and December 2019. The investigators will extract data at the time of care home admission including age, sex, ethnicity, coded diagnosis of hypertension, indices of frailty and risk of falls as well as comorbidities relevant to cardiovascular risk and falls risk. Analysis will include looking at the prevalence of hypertension amongst the care home population, describing treatment patterns (i.e. number and type of prescribed anti-hypertensive medications, frequency of blood pressure monitoring) and the proportion of patients with blood pressure controlled according to National Institute of Health and Care Excellence (NICE) guidelines. The investigators will also look to establish whether there are any changes in the number and type of prescribed antihypertensive medication before and after admission to a care home (i.e. intensification of pharmacological therapy or deprescribing) and whether this differs amongst different subgroups of populations including patients with terminal illness and stroke diagnosis. The investigators will also estimate frequency of falls in the year following care home admission.

Eligibility criteria: Inclusion Criteria:

* registered to a GP practice contributing to the Connected Bradford dataset at the point of admission
* a recorded length of stay in a care home of longer than six weeks
* recorded social care entry for nursing or residential care in the Bradford council social care data.

Exclusion Criteria:

* no exclusion criteria applied to keep the sample representative of the real-world care home population.

Primary outcomes:
measure: Frequency of blood pressure measurements
timeFrame: from the point of admission up to 12 months following admission
measure: change in antihypertensive medication
timeFrame: 6 months before admission to 6 months following admission
measure: Injurious falls
timeFrame: from the point of admission up to 12 months after admission
Secondary outcomes:
measure: Prevalence of hypertension
timeFrame: at the day of admission to a care home (this will vary between each individual)
measure: Antihypertensive medication
timeFrame: at the day of admission to a care home (this will vary between each individual)
measure: Blood pressure treatment
timeFrame: 12 months following admission
Other outcomes:
measure: change in systolic pressure following care home admission
timeFrame: 12 months before admission for the first measure and 12 months after admission for the second measure.
Locations:
city: Bradford
country: United Kingdom
facility: Academic Unit for Ageing and Stroke Research
state: West Yorkshire
Study officials:
References: