Predictors of Blood Pressure Control and Associations With Cardiovascular Diseases in Individuals With High Blood Pressure: a CALIBER Study
- Conditions
- StrokeMyocardial InfarctionStable Angina PectorisHeart Failure
- Registration Number
- NCT02285322
- Lead Sponsor
- University College, London
- Brief Summary
Current guidelines for the clinical management of hypertension in adults recommend to achieve and maintain blood pressure levels of \<140/90 mmHg. However, it is uncertain what proportion of individuals identified with high blood pressure in primary care actually reach blood pressure control, what factors are associated with attainment of control and to what extent blood pressure control attainment is associated with cardiovascular diseases in a contemporary population of individuals diagnosed with high blood pressure.
The aim of this study is to investigate the extent to which patients achieve blood pressure control and associated risk factors, time to attainment of blood pressure control and whether this time is associated with an increased risk of CVD onset, all-cause and cardiovascular disease and end-stage renal disease.
- Detailed Description
An increment of 20 mmHg of systolic blood pressure (or approximately equivalent 10 mmHg diastolic blood pressure) is associated with more than a two-fold increase in risk of fatal stroke, and with a two-fold increase in fatal ischemic heart diseases in individuals aged 40-69 years. The management and control of high blood pressure is therefore one of the most important components of primary and secondary strategies for prevention of cardiovascular mortality and morbidity. Current guidelines for the clinical management of hypertension in adults recommend to achieve and maintain blood pressure levels of \<140/90 mmHg. However, it is uncertain what proportion of individuals identified with high blood pressure in primary care actually reach blood pressure control, what factors are associated with attainment of control and to what extent blood pressure control attainment is associated with cardiovascular diseases in a contemporary population of individuals diagnosed with high blood pressure. This is important for clinicians and policy decision makers in order to design and implement effective strategies for patient management.
The aim of this study is to investigate the extent to which patients achieve blood pressure control and associated risk factors, time to attainment of blood pressure control and whether this time is associated with an increased risk of CVD onset, all-cause and cardiovascular disease and end-stage renal disease.
The study will use data from the CALIBER data set of clinically collected electronic health record data from England.
This study is part of the CALIBER (Cardiovascular disease research using linked bespoke studies and electronic records) programme funded over 5 years from the National Institute for Health Research (NIHR) and Wellcome Trust. The central theme of the CALIBER research is linkage of the Myocardial Ischaemia National Audit Project (MINAP) with primary care (Clinical Practice Research Datalink - CPRD) and other resources. The overarching aim of CALIBER is to better understand the aetiology and prognosis of specific coronary phenotypes across a range of causal domains, particularly where electronic records provide a contribution beyond traditional studies. CALIBER has received both Ethics approval (ref 09/H0810/16) and ECC approval (ref ECC 2-06(b)/2009 CALIBER data set).
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- All
- Target Recruitment
- 200000
- Patients aged 18 and over
- Registered with a participating general practice during the study period
- Minimum one year of records prior to study entry meeting CPRD data quality
- Diagnosed with high blood pressure in the period January 1997 - March 2010
- Patients without record of gender
- Patients with prior atherosclerotic disease, as recorded in primary care or hospitalisation data
- Patients with less than 6 months of follow-up since diagnosis of high blood pressure
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method First presentation of cardiovascular disease 10 years First recorded diagnosis of cardiovascular disease during follow-up: myocardial infarction, stroke (haemorrhagic or ischemic), heart failure, coronary revascularisation
Risk factors for blood pressure control 10 years Investigation of baseline factors associated with blood pressure control attainment during follow-up
All-cause mortality 10 years Recorded death of any cause during follow-up
Cardiovascular mortality 10 years Recorded death due to cardiovascular disease during follow-up
Coronary revascularisation 10 years First recorded percutaneous coronary intervention or coronary artery bypass graft (excluding interventions performed within 30 days before or after a diagnosis of myocardial infarction)
- Secondary Outcome Measures
Name Time Method First presentation of cardiovascular disease 10 years First recorded diagnosis of cardiovascular disease during follow-up: stable angina pectoris and atrial fibrillation
End-stage renal disease 10 years Recorded kidney disease resulting in dialysis or kidney transplantation during follow-up
Management of high blood pressure 6 months after cohort entry Description of patient management in the 6 months after diagnosis of high blood pressure in terms of: blood pressure lowering medication start, timing and class; smoking cessation; dietary advice; physical activity; weight and total cholesterol decrease; and HDL-cholesterol increase
Trial Locations
- Locations (1)
University College London
🇬🇧London, United Kingdom