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

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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.