PRedicting Out of OFfice Blood Pressure in the clinic (PROOF-BP)

预测诊所外血压 (PROOF-BP)

• 批准号: MR/K022032/1
• 负责人: James Sheppard
• 金额: $ 38.77万
• 依托单位: University of Oxford
• 依托单位国家: 英国
• 项目类别: Fellowship
• 财政年份: 2013
• 资助国家: 英国
• 起止时间: 2013 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FK022032%2F1
• 关键词: PRedicting; Out; OFfice; Blood; Pressure

Heart attacks and strokes are the main cause of death and disability in the developed world. Patients with high blood pressure (hypertension) are more likely to suffer a heart attack or stroke. The risk of this happening can be significantly reduced with drugs which lower blood pressure. Accurate measurement of blood pressure is therefore vital to ensure that patients with high blood pressure are recognised and treated appropriately.New clinical guidelines recommend that blood pressure is measured for 24 hours to confirm patients with high blood pressure. Measuring blood pressure for 24 hours is obviously time consuming, but also expensive and often uncomfortable for patients. Despite this, it is recommended because it reduces the number of patients being incorrectly diagnosed with high blood pressure. Incorrect diagnoses occur because patients who are anxious when they visit the doctor's surgery often have high blood pressure which then decreases to normal levels when they return home. This is known as the white coat effect. These patients do not require treatment with blood pressure lowering drugs but may be prescribed them because the doctor doesn't realise that the reason their blood pressure is raised is because they are anxious. Incorrect prescription of these drugs may have bad consequences for the patient and is a waste of NHS money.This project aims improve the accuracy of blood pressure measurement in the doctor's surgery and thus reduce the need for 24 hour measurements. Using a new blood pressure measurement technique, our pilot work suggests that it is possible to predict which patients have high blood pressure because they are anxious and which patients have true raised blood pressure requiring treatment. This new technique could identify which patients can be treated on the basis of blood pressure measurements made in the doctor's surgery and therefore reduce the number of patients needing to undergo expensive, uncomfortable, 24 hour measurement. It could therefore improve the quality of patient care and save money for the NHS. The aim of this project is to establish how good this new technique is at predicting true blood pressure and whether it can be used on a day-to-day basis in the doctor's surgery. The effectiveness of this blood pressure measurement technique will be investigated using existing data collected from a typical population of patients in primary care. This analysis will establish the inputs required to develop a blood pressure measurement tool for use in the doctor's surgery. This tool will then be developed and tested it on patients from doctor's surgeries across Birmingham. The final stage of the project will involve comparing the performance of the new tool against the standard method of blood pressure measurement currently being used (patients with suspected high blood pressure being sent for 24 hour measurement) in the context of a clinical trial. Only the initial planning (pilot) for this clinical trial will be completed during this fellowship. Further funding will be sought to complete this clinical trial after the fellowship has concluded. The project will not involve the use of medicinal products (drugs) or human tissue.The Fellow will conduct all analyses of existing datasets proposed in this project with the assistance of colleagues in the host institution. The development of a blood pressure measurement tool will be done with assistance from the IT programming team in the Primary Care Clinical Research and Trials Unit at the University of Birmingham.

心脏病发作和中风是发达国家死亡和残疾的主要原因。高血压患者更容易患心脏病或中风。这种情况发生的风险可以通过降低血压的药物显着降低。因此，准确测量血压对于确保高血压患者得到正确的识别和治疗至关重要。新的临床指南建议测量24小时的血压以确认高血压患者。24小时测量血压显然很耗时，但也很昂贵，而且患者往往感到不舒服。尽管如此，它还是被推荐的，因为它减少了被错误诊断为高血压的患者数量。错误的诊断发生，因为病人谁是焦虑时，他们参观医生的手术往往有高血压，然后下降到正常水平，当他们回家。这被称为白色外套效应。这些患者不需要降压药物治疗，但可能会被开处方，因为医生没有意识到他们血压升高的原因是因为他们焦虑。这些药物的不正确处方可能会对患者造成不良后果，并且浪费NHS的资金。该项目旨在提高医生手术中血压测量的准确性，从而减少24小时测量的需求。使用一种新的血压测量技术，我们的试点工作表明，有可能预测哪些患者因为焦虑而患有高血压，哪些患者确实需要治疗。这项新技术可以根据医生手术中测量的血压来确定哪些患者可以接受治疗，从而减少需要接受昂贵、不舒服的24小时测量的患者数量。因此，它可以提高病人护理的质量，并为NHS节省资金。该项目的目的是确定这种新技术在预测真实血压方面的效果如何，以及它是否可以在医生的日常手术中使用。将使用从初级保健典型患者群体收集的现有数据来研究这种血压测量技术的有效性。该分析将建立开发用于医生手术的血压测量工具所需的输入。然后，该工具将被开发并在伯明翰医生手术的患者身上进行测试。该项目的最后阶段将涉及在临床试验的背景下，将新工具的性能与目前使用的标准血压测量方法（将疑似高血压患者送去进行24小时测量）进行比较。本研究期间仅完成本临床试验的初步计划（试点）。研究结束后，将寻求进一步的资金来完成这项临床试验。该项目将不涉及使用医药产品（药物）或人体组织。研究员将在主办机构同事的协助下，对该项目提议的现有数据集进行所有分析。血压测量工具的开发将在伯明翰大学初级保健临床研究和试验部门的IT编程团队的协助下完成。

项目成果

Predicting out-of-office blood pressure level using repeated measurements in the clinic: an observational cohort study.

• DOI: 10.1097/hjh.0000000000000319
• 发表时间: 2014-11
• 期刊: Journal of hypertension
• 影响因子: 4.9
• 作者: Sheppard JP;Holder R;Nichols L;Bray E;Hobbs FD;Mant J;Little P;Williams B;Greenfield S;McManus RJ
• 通讯作者: McManus RJ

Prevalence and predictors of hospital prealerting in acute stroke: a mixed methods study.

• DOI: 10.1136/emermed-2014-204392
• 发表时间: 2016-07
• 期刊: Emergency medicine journal : EMJ
• 作者: Sheppard JP;Lindenmeyer A;Mellor RM;Greenfield S;Mant J;Quinn T;Rosser A;Sandler D;Sims D;Ward M;McManus RJ;CLAHRC BBC investigators
• 通讯作者: CLAHRC BBC investigators

Receptionist rECognition and rEferral of PaTients with Stroke (RECEPTS) study - protocol of a mixed methods study.

• DOI: 10.1186/1471-2296-15-91
• 发表时间: 2014-05-12
• 期刊: BMC family practice
• 影响因子: 2.9
• 作者: Sheppard JP;Singh S;Jones J;Bates E;Skelton J;Wiskin C;McManus RJ;Mellor RM
• 通讯作者: Mellor RM

When has service provision for transient ischaemic attack improved enough? A discrete event simulation economic modelling study.

• DOI: 10.1136/bmjopen-2017-018189
• 发表时间: 2017-11-25
• 期刊: BMJ open
• 影响因子: 2.9
• 作者: Barton P;Sheppard JP;Penaloza-Ramos CM;Jowett S;Ford GA;Lasserson D;Mant J;Mellor RM;Quinn T;Rothwell PM;Sandler D;Sims D;McManus RJ;BBC CLAHRC investigators
• 通讯作者: BBC CLAHRC investigators

Diagnosis and management of resistant hypertension.

顽固性高血压的诊断和治疗。

• DOI: 10.1136/heartjnl-2015-308297
• 发表时间: 2017
• 期刊: Heart (British Cardiac Society)
• 作者: Sheppard JP