Blood Pressure Management in the Care Home Population (BPITCH)

Describing the Management of Hypertension in a UK Care Home Population

The UK care home population is projected to increase significantly over the coming decades. A high proportion of individuals in a care home have multiple long-term conditions and take large amounts of prescribed medication. This means they are routinely excluded from research studies and so there is little evidence on which to base treatment of long-term conditions such as high blood pressure. Furthermore, given that 1 in 4 people admitted into a care home die within 1 year, the benefit of treating high blood pressure to reduce the risk of heart attack or stroke must be balanced with the need to optimise quality of life. The aim of this study is to describe the health and social characteristics of the UK care home population with a particular focus on the management of blood pressure in the population. It is hoped that the findings of this study will help inform future research into the management of chronic conditions in care home residents.

Study Overview

• Status: Active, not recruiting
• Conditions: Hypertension; Aging

Detailed Description

The investigators will use the connected Bradford dataset to examine UK electronic health records to describe the UK care home population and management of hypertension in this population. The sample will include all adults aged 65 and over who have been admitted into a care home between January 2016 and December 2019. The investigators will extract data at the time of care home admission including age, sex, ethnicity, coded diagnosis of hypertension, indices of frailty and risk of falls as well as comorbidities relevant to cardiovascular risk and falls risk. Analysis will include looking at the prevalence of hypertension amongst the care home population, describing treatment patterns (i.e. number and type of prescribed anti-hypertensive medications, frequency of blood pressure monitoring) and the proportion of patients with blood pressure controlled according to National Institute of Health and Care Excellence (NICE) guidelines. The investigators will also look to establish whether there are any changes in the number and type of prescribed antihypertensive medication before and after admission to a care home (i.e. intensification of pharmacological therapy or deprescribing) and whether this differs amongst different subgroups of populations including patients with terminal illness and stroke diagnosis. The investigators will also estimate frequency of falls in the year following care home admission.

• Study Type: Observational
• Enrollment (Estimated): 3000

Contacts and Locations

Study Locations

• United Kingdom
  • West Yorkshire
    • Bradford, West Yorkshire, United Kingdom, BD9 6RJ
      • Academic Unit for Ageing and Stroke Research

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Older Adult
• Accepts Healthy Volunteers: N/A

• Sampling Method: Non-Probability Sample

Study Population

Care home residents in the Bradford metropolitan area. The Bradford population has high levels of deprivation and ethnic diversity; a large proportion of the population identify as Pakistani ethnicity.

Description

Inclusion Criteria:

• registered to a GP practice contributing to the Connected Bradford dataset at the point of admission
• a recorded length of stay in a care home of longer than six weeks
• recorded social care entry for nursing or residential care in the Bradford council social care data.

Exclusion Criteria:

• no exclusion criteria applied to keep the sample representative of the real-world care home population.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort
Care home cohort; Individuals aged 65 or over registered to a GP practice which is part of the Connected Bradford Database who have been admitted to a CH between January 2016 and January 2020, with a recorded length of stay more than 6 weeks, will be included in the study.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Frequency of blood pressure measurements	the proportion of individuals entering a care home, with a diagnosis of hypertension, have their blood pressure measured in the year following admission	from the point of admission up to 12 months following admission
change in antihypertensive medication	change in the number or type of antihypertensive mediation from six months before care home admission to six months following care home admission	6 months before admission to 6 months following admission
Injurious falls	one year incidence of a fall resulting in hospital attendance in those entering a care home	from the point of admission up to 12 months after admission

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Prevalence of hypertension	the proportion of individuals in the care home cohort with a diagnosis of hypertension at the point of care home admission	at the day of admission to a care home (this will vary between each individual)
Antihypertensive medication	the number and type of antihypertensive medication prescribed at the point of admission	at the day of admission to a care home (this will vary between each individual)
Blood pressure treatment	of those with a diagnosis of hypertension and a blood pressure value recorded in the 12 months after admission, proportion a blood pressure value below the target set by the National Institute for Health and Care Excellence (i.e. for those aged 80 and over 150/90 and those aged below 80 years 140/90)	12 months following admission

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
change in systolic pressure following care home admission	the difference between systolic blood pressure recorded before care home admission (defined as less than 12 months for care home admission) and systolic blood pressure recorded after care home admission (blood pressure recorded within 12 months following admission)	12 months before admission for the first measure and 12 months after admission for the second measure.

Collaborators and Investigators

• Sponsor: University of Leeds
• Collaborators: Bradford Teaching Hospitals NHS Foundation Trust

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2016
• Primary Completion (Actual): January 1, 2020
• Study Completion (Estimated): June 1, 2024

Study Registration Dates

• First Submitted: March 14, 2024
• First Submitted That Met QC Criteria: March 22, 2024
• First Posted (Actual): March 29, 2024

Study Record Updates

• Last Update Posted (Actual): March 29, 2024
• Last Update Submitted That Met QC Criteria: March 22, 2024
• Last Verified: March 1, 2024

More Information

Terms related to this study

• Keywords: Nursing Home; Deprescribing; Residential Home
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Hypertension
• Other Study ID Numbers: CB_CY_P09_23_11

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: using anonymised routine health data so cannot be shared. Will share code used to identify cohort with identifiers removed

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No