James P Sheppard1, Mark Lown2, Jenni Burt3, Eleanor Temple1, Rebecca Lowe1, Hannah Ashby1, Oliver Todd4, Julie Allen1, Gary A Ford5, Rosalyn Fraser1, Carl Heneghan1, F D Richard Hobbs1, Sue Jowett6, Paul Little2, Jonathan Mant7, Jill Mollison1, Rupert Payne8, Marney Williams9, Ly-Mee Yu1, Richard J McManus1. 1. Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. 2. Primary Care Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Southampton, UK. 3. The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK. 4. Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Leeds, UK. 5. Radcliffe Department of Medicine, University of Oxford, Oxford, UK. 6. Institute of Applied Health Research, University of Birmingham, Birmingham, UK. 7. Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK. 8. Centre for Academic Primary Care, University of Bristol, Bristol, UK. 9. Patient and Public Involvement Representative, London, UK.
Abstract
BACKGROUND/ OBJECTIVES: Randomized controlled trials are used to inform clinical guidelines on the management of hypertension in older adults, but it is unclear to what extent these trials represent the general population attending routine clinical practice. This study aimed to define the proportion and characteristics of patients eligible for hypertension trials conducted in older people. DESIGN: Cross-sectional study. SETTING: A total of 24 general practices in England. PARTICIPANTS: Anonymized electronic health record data from all individuals aged 80 and older. MEASUREMENTS: Descriptive statistics were used to define the proportion and characteristics of patients eligible for two previous medication intensification trials (HYVET, SPRINT) and one medication reduction trial (OPTiMISE). A logistic regression model was constructed to estimate predictors of eligibility for each trial. RESULTS: Of 15,376 patients identified, 268 (1.7%; 95% confidence interval [CI] = 1.5-2.0%), 5,290 (34.4%; 95%CI = 33.7-35.2%), and 3,940 (25.6%; 95%CI = 24.9-26.3%) were eligible for the HYVET, SPRINT, and OPTiMISE trials, respectively. Between 5.6% and 30.7% of exclusions from each trial were due to eligibility criteria excluding those with high or uncontrolled blood pressure. Frailty (odds ratio [OR] = .44; 95%CI = .36-.54 [OPTiMISE]), cardiovascular polypharmacy (OR = .61; 95%CI = .55-.68 [SPRINT]) and multimorbidity (OR = .72; 95%CI = .64-.82 [SPRINT]) were associated with a lower likelihood of being eligible for one or more of the trials. CONCLUSION: A possible unintended consequence of blood pressure criteria used by trials attempting to answer different primary questions is that for many older patients, no trial evidence exists to inform treatment decisions in routine practice. Caution should be exercised when applying results from existing trials to patients with frailty or multimorbidity.
BACKGROUND/ OBJECTIVES: Randomized controlled trials are used to inform clinical guidelines on the management of hypertension in older adults, but it is unclear to what extent these trials represent the general population attending routine clinical practice. This study aimed to define the proportion and characteristics of patients eligible for hypertension trials conducted in older people. DESIGN: Cross-sectional study. SETTING: A total of 24 general practices in England. PARTICIPANTS: Anonymized electronic health record data from all individuals aged 80 and older. MEASUREMENTS: Descriptive statistics were used to define the proportion and characteristics of patients eligible for two previous medication intensification trials (HYVET, SPRINT) and one medication reduction trial (OPTiMISE). A logistic regression model was constructed to estimate predictors of eligibility for each trial. RESULTS: Of 15,376 patients identified, 268 (1.7%; 95% confidence interval [CI] = 1.5-2.0%), 5,290 (34.4%; 95%CI = 33.7-35.2%), and 3,940 (25.6%; 95%CI = 24.9-26.3%) were eligible for the HYVET, SPRINT, and OPTiMISE trials, respectively. Between 5.6% and 30.7% of exclusions from each trial were due to eligibility criteria excluding those with high or uncontrolled blood pressure. Frailty (odds ratio [OR] = .44; 95%CI = .36-.54 [OPTiMISE]), cardiovascular polypharmacy (OR = .61; 95%CI = .55-.68 [SPRINT]) and multimorbidity (OR = .72; 95%CI = .64-.82 [SPRINT]) were associated with a lower likelihood of being eligible for one or more of the trials. CONCLUSION: A possible unintended consequence of blood pressure criteria used by trials attempting to answer different primary questions is that for many older patients, no trial evidence exists to inform treatment decisions in routine practice. Caution should be exercised when applying results from existing trials to patients with frailty or multimorbidity.
Authors: Sue Jowett; Shahela Kodabuckus; Gary A Ford; F D Richard Hobbs; Mark Lown; Jonathan Mant; Rupert Payne; Richard J McManus; James P Sheppard Journal: Hypertension Date: 2022-03-10 Impact factor: 9.897
Authors: Andrew Clegg; Karen Bandeen-Roche; Amanda Farrin; Anne Forster; Thomas M Gill; John Gladman; Ngaire Kerse; Richard Lindley; Richard J McManus; Rene Melis; Ruben Mujica-Mota; Parminder Raina; Kenneth Rockwood; Ruth Teh; Danielle van der Windt; Miles Witham Journal: Age Ageing Date: 2022-04-01 Impact factor: 12.782
Authors: Peter Hanlon; Neave Corcoran; Guy Rughani; Anoop S V Shah; Frances S Mair; Bruce Guthrie; Joanne P Renton; David A McAllister Journal: Lancet Healthy Longev Date: 2021-07
Authors: Ali Albasri; Miriam Hattle; Constantinos Koshiaris; Anna Dunnigan; Ben Paxton; Sarah Emma Fox; Margaret Smith; Lucinda Archer; Brooke Levis; Rupert A Payne; Richard D Riley; Nia Roberts; Kym I E Snell; Sarah Lay-Flurrie; Juliet Usher-Smith; Richard Stevens; F D Richard Hobbs; Richard J McManus; James P Sheppard Journal: BMJ Date: 2021-02-10