OPtimising Treatment for MIld Systolic hypertension in the Elderly (OPTiMISE)
- Principal Investigator: James Sheppard
- 1 October 2016 to 31 May 2019
- Project No: 336
- Funding round: FR 12
The population is getting older (over 3 million people [5%] in the UK are >80 years) and the number of people living with multiple long-term conditions taking multiple drugs is increasing. High blood pressure is one of the most common conditions in older patients and up to half of this population receive two or more drugs to treat it. However, recent evidence suggests that large reductions in blood pressure, and too many drug prescriptions may be associated with an increase in serious falls and death in the elderly.
This study aims to assess the safety of reducing the number of drugs prescribed to 540 older patients (>80 years) who have controlled systolic blood pressure on treatment. The trial will compare the proportion of patients with safe systolic blood pressure levels (<150mmHg) at follow-up in those randomly allocated to either reduction of blood pressure lowering medication with self-monitoring or usual care (continued treatment). Quality of life will also be assessed both in questionnaires and through patient interviews. These interviews will be used to understand the barriers and facilitators to antihypertensive medication reduction as well as what it is that older people most value in terms of quality and quantity of life. We will use mathematical modelling to predict the long effects of any observed changes in blood pressure and quality of life and understand whether further research is needed, for instance, a larger scale clinical trial.
Overall, it is hoped that this work will establish whether medication reduction in older patients can be achieved safely and enable us to understand how the drivers of quality of life including side effects of treatment (e.g. falls) and medication burden balance any potential risks.
James Sheppard (Oxford), Jenni Burt (Cambridge), Mark Lown (Southampton), Rupert Payne (Bristol), Richard McManus (Oxford), Paul Little (Southampton), John Benson and Jonathan Mant (Cambridge), Richard Hobbs and Carl Heneghan (Oxford) and Sue Jowett, Emma Ogburn and Ly-Mee Yu (Oxford).
Amount awarded: £534,382