Maximising medication adherence and minimising physician inertia: Lowering to target the blood pressure of older patients with hypertension – A cluster randomised feasibility study in general practice

High blood pressure can lead to strokes and heart disease. Despite treatment, many patients continue to have uncontrolled blood pressure. In Ireland, we do very badly in this area – the worst of sixteen high income countries worldwide. For example, the proportion of Irish male patients with controlled blood pressure is 17% – in Canada, 69%. Our study will address this.

Over three years, we will develop a new treatment (our ‘intervention’) for people aged 65 and older, whose blood pressure remains high despite taking two or more medications. Our intervention will have two goals:

1. Support people to take their medications as prescribed

2. Support doctors to act in lowering patients blood pressure when they recognise the need to do so.

For the first 12 months we will, with patients and health staff, design and further develop the intervention. We will then run (months 13-36) a pilot cluster randomised controlled trial to see if it is worthwhile to go to a full trial. We will ask 120 people attending 8 different GP practices to take part. We will measure their blood pressure over 24 hours and how much blood pressure medication is present in their urine. In one half of GP practices, people will be treated as they currently are. In the other half, based on the above intervention, people will agree a personalised action plan with their GP. Practices will follow-up patients after one and six months.

We will record what patients and GPs think about the intervention. This will determine if it can be improved, and if it looks like a promising treatment.

Are you interested in getting involved?

We are looking for members of the public to become involved as co-researchers. This involvement is known as ‘Public and Patient Involvement’, or ‘PPI’ for short. PPI in research means that the people who are likely be affected by the results of the research are directly involved in, and shape, the decisions made in planning and conducting the research and in interpreting and communicating the research results. With PPI, research is carried out “with” and “by” the public, rather than “to” “for” or “about” them.

While we (the research team) will bring our own expertise, we do not have personal, lived experience of high blood pressure. Patients and researchers can therefore collaborate to conduct high-quality research with patient needs forming a clear part in that research.

Signing up as a PPI contributor for this project would involve attending approximately 10 meetings, many online, over three years. You would work with the research team on tasks such as developing study materials and sharing the study results.

You can read more about PPI in health research here.

If you are interested in getting involved, or hearing more you can contact the Project Manager, Dr Eimear Morrissey, on eimear.morrissey@nuigalway.ie