Read a BITE sized summary of this project.
In 2003 the prevalence of hypertension in England was 31.7% in men and 29.5% in women (NCSR 2004). Hypertension is a major cause of cardiovascular morbidity and mortality throughout the world and is estimated to have accounted for 7.6million premature deaths worldwide in 2001. This represents about 13.5% of total global deaths. Since the prevalence of hypertension increases with age, and many societies are faced with ageing populations, management of hypertension will continue to be an increasing public health problem globally.
We have published a systematic review of nurse led interventions in hypertension and plan to extend this work by reviewing the evidence base for allied health professional led interventions to improve the control of hypertension. We aim to elucidate whether nurse or pharmacist prescribing is an important component of this complex intervention.
We have also helped to establish the prevalence of the inter-arm blood pressure difference phenomenon and its associations with peripheral vascular disease and reduced cardiovascular event-free survival. Whilst the majority of GPs are aware of this phenomenon and its use as a marker for increased cardiovascular risk, only a minority check for it and there is an implementation gap between knowledge and clinical practice. We therefore intend to develop a means of disseminating the importance of this finding along with methods for implementing the use of inter-arm difference detection in primary care.
1. Work on health professional led interventions in the management of hypertension
- To review the evidence base for allied health professional led interventions to improve the control of hypertension.
- To elucidate whether nurse or pharmacist prescribing is an important component of this complex intervention.
- To identify areas in need of further study.
2. Pilot work to establish the feasibility and rationale for a primary care intervention using inter-arm difference detection as an indicator of increased cardiovascular risk
- Establish the strength of existing evidence for inter-arm difference as a sign of peripheral vascular disease.
- Explore and pilot an educational and/or clinical intervention
- Verify this potential risk marker in other representative community cohorts
- Modelling study to look at primary care intervention
- Develop primary care intervention for pilot study
Related news stories:
- Clark CE, Smith LFP, Glynn LG, Taylor RS, Campbell J. Allied health professional-led interventions for improving control of blood pressure in patients with hypertension. Cochrane Database of Systematic Reviews 2011, Issue 11.
- Clark CE, Smith LFP, Harding G, Taylor RS, Campbell JL. Nurse led hypertension clinics: evolving ahead of the evidence? Presented at BHS, Cambridge, September 13th 201. J Hum Hypertens 2011: 25 (S1) S6
- Clark CE, Smith LFP, Taylor RS, Campbell JL Nurse led hypertension clinics: evidence of benefit or absence of a white coat? Oral presentation RCGP Annual Conference Liverpool 20th –22nd October 2011.
- Clark CE, Taylor RS, Shore AC, Ukoumunne OC, Campbell J. The association of an inter-arm difference in systolic blood pressure with vascular disease and mortality: A systematic review and meta-analysis. Lancet 2012. doi:10.1016/S0140-6736(08)61345-8
- Clark CE, Smith LFP, Taylor RS, Campbell JL. Nurse led interventions to control of blood pressure in people with hypertension: systematic review and meta-analysis BMJ 2010;341:c3995
- Clark CE, Smith LFP, Taylor R S and Campbell JL (2011). Nurse-led interventions used to improve control of high blood pressure in people with diabetes: a systematic review and meta-analysis. Diabetic Medicine, 28: 250–261. doi: 10.1111/j.1464-5491.2010.03204.x
- Clark CE, Shore A, Taylor R, Campbell J. A systolic inter-arm blood pressure difference in hypertension is associated with reduced ten year survival: primary care cohort study. BMJ in press
- Winner – Best Research Poster – RCGP Harrogate October 2010
- Clark CE, Shore A, Taylor R, Campbell J. A systolic inter-arm blood pressure difference is associated with increased cardiovascular and all-cause mortality in hypertension: meta-analysis Journal of Hypertension 2011 29: e-Supplement A, e117 ; Presented at ESH Milan 17th -20th June 2011 ; Presented at BHS, Cambridge, September 13th 2011 ; J Hum Hypertens 2011: 25 (S1) S9 ; Presented at SAPC Bristol July 2011; Primary Health Care Research & Development 2011; 12 (S1): 9-10 ; Shortlisted for NAPCRG travel award