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

在发达国家，心脏病发作和中风是导致死亡和残疾的主要原因。患有高血压(高血压)的患者更容易心脏病发作或中风。这种情况发生的风险可以通过使用降低血压的药物来显著降低。因此，准确测量血压对确保高血压患者得到识别和适当治疗至关重要。新的临床指南建议24小时测量血压，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，而且经常让患者感到不舒服。尽管如此，还是推荐这样做，因为它减少了被误诊为高血压的患者数量。之所以会出现错误的诊断，是因为那些看医生手术时感到焦虑的患者往往患有高血压，当他们回家后，血压会下降到正常水平。这就是所谓的白大褂效应。这些患者不需要用降压药治疗，但可能会开出降压药，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。这些药物的错误处方可能会给患者带来不良后果，是对NHS资金的浪费。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小时测量的需要。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，哪些患者确实血压升高需要治疗。这项新技术可以根据医生在手术中进行的血压测量来确定哪些患者可以接受治疗，从而减少需要接受昂贵的、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。这个项目的目的是确定这项新技术在预测真实血压方面有多好，以及它是否可以在医生手术的日常基础上使用。这种血压测量技术的有效性将使用从初级保健患者的典型人群中收集的现有数据进行调查。这项分析将确定开发用于医生手术的血压测量工具所需的输入。然后，该工具将被开发出来，并在伯明翰各地医生诊所的患者身上进行测试。该项目的最后阶段将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(疑似高血压患者被送去进行24小时测量)进行比较。在此期间，将只完成这项临床试验的初步计划(试点)。在奖学金结束后，将寻求进一步的资金来完成这项临床试验。该项目不涉及医药产品(药物)或人体组织的使用。该研究员将在主办机构的同事的协助下，对该项目中提出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。

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.