Blood pressure lowering drugs are extremely effective in reducing heart attacks and strokes. In the UK, only patients whose blood pressures are above a certain threshold are considered for treatment. However, recent research studies have shown that even patients with blood pressures below that threshold might benefit from treatment and therefore the current approach may not be the best way to save lives. Other possible approaches to blood pressure lowering treatment include treating based on a patient's age and sex (e.g. treat men >55 and women >65 years), or treating based on a patient's overall cardiovascular disease risk, which takes into account other factors like diabetes, smoking and older age. This approach is used for deciding who should be offered statins. This research aims to provide information to help decide which of four proposed strategies for recommending blood pressure treatment is best for population health. In particular, we will analyse primary care and linked hospital records from CPRD to first work out the number of patients who would be eligible for treatment under each suggested approach, and second, to look at which strategy prioritises treatment to patients who go on to experience heart attacks and strokes.
The current approach to blood pressure treatment in the UK relies predominantly on blood pressure thresholds. This ignores evidence showing that treatment lowers cardiovascular disease (CVD) risk at all blood pressures, with no threshold. One alternative treatment approach would be to use a threshold of overall CVD risk, a strategy that is now accepted for lipid lowering drugs. Another suggested approach is to use age and sex to determine treatment. To help decide on the optimal strategy for population health, there are two key considerations: the number of patients who would be eligible for treatment under each strategy, and whether the strategy prioritises treatment to patients with the highest future burden of CVD. This protocol describes a cohort study to investigate eligibility for blood pressure lowering treatment under four different approaches (i) current NICE guideline, (ii) blood pressure alone (to reflect evidence that some GPs are ignoring the NICE guideline), (iii) cardiovascular risk, and (iv) age/sex. Beginning in 2011, the cohort will be split according to treatment eligibility under each strategy, and followed up for their first cardiovascular disease event. Rates and proportions of events, according to treatment eligibility, will be reported.
Eligibility for blood pressure lowering treatment; Cardiovascular disease.
Emily Herrett - Chief Investigator - London School of Hygiene & Tropical Medicine ( LSHTM )
Emily Herrett - Corresponding Applicant - London School of Hygiene & Tropical Medicine ( LSHTM )
Adam Timmis - Collaborator - Queen Mary University of London
Elizabeth Williamson - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Krishnan Bhaskaran - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Liam Smeeth - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Reecha Sofat - Collaborator - University College London ( UCL )
Rod Jackson - Collaborator - University of Auckland
Tjeerd van Staa - Collaborator - University of Manchester
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Townsend Score;Practice Level Index of Multiple Deprivation