Optimising the diagnosis and management of hypertension in primary care through self monitoring of blood pressure

Aims and objectivesTo assess the role of self-monitoring in screening for hypertension, cardiovascular risk assessment and achieving BP targets, arranged across three work streams and twelve research questions.BackgroundHypertension is a key risk factor for cardiovascular disease but its detection and management is currently sub-optimal. Self-monitoring of hypertension is under utilised in primary care despite around a third of patients practicing it, largely due to a deficient evidence base. It has the potential to increase detection of hypertension and improve BP control.Research PlansThe proposed programme will provide the evidence to underpin the integration of self-monitoring of blood pressure (BP) into daily practice in primary care. The major areas of study are set out below in three work streams (WS): 1 Self-monitoring in the screening of hypertension 1-1 Systematic review of self- screening in hypertension 1-2 Survey of screening plus interviews to judge current and future practice 1-3 Pilot testing of self-screening intervention 2 Statistical and health economic modelling 2-1 Re-calibration of cardiovascular (CV) risk scores 2-2 Testing re-calibration in practice 2-3 Economic modelling of hypertension screening and CV risk assessment 2-4 Statistical modelling of screening BP to predict future BP 3 Self-monitoring in the management of hypertension 3-1 Systematic review of self-monitoring protocols 3-2 Calibration of patients own BP monitors 3-3 Trial of managing hypertension using self-monitored BP 3-4 Health economic and modelling sub study 3-5 Qualitative sub study.Research TeamThe programme is a collaboration of South Birmingham PCT with Primary Care Departments from Birmingham, Oxford and Cambridge. The applicants form a multidisciplinary team including social scientists, clinicians, patients, administrators and a health service manager.Programme Management - McManus Programme Lead, Bray Programme Manager. - Six monthly steering group - 1-3 monthly senior management group (telecon) with PPI input - Monthly investigator meetings (Birmingham and Oxford)Research EnvironmentThree leading primary care cardiovascular research teams from founder members of the National School of Primary Care Research. Applicants have worked together on self-monitoring in hypertension in various combinations over the last ten years.Anticipated OutputsNew evidence from this programme will, if positive, allow the full integration of self-monitoring of BP into primary care, leading to better cardiovascular risk reduction. These results are likely to significantly influence future NICE hypertension and cardiovascular risk guidelines. Applicants have close links to the Blood Pressure Association and British Hypertension Society.PPILay representatives from both Birmingham and Oxford are fully integrated into steering and senior management groups and have influenced this application, particularly with respect to programme management.Ethical ImplicationsKey issues are confidentiality, informed consent, and ensuring that participation in the research does not lead to inferior care. Strict procedures for data protection will be enforced with a careful consenting process and best practice used as the comparator where care is randomised.Justification of Resources£2 million over five years will fund 2 systematic reviews, development and piloting of self-screening of hypertension, surveys of community BP screening providers, at least 60 depth interviews, focus groups and four statistical and economic modelling studies. A trial of self-monitoring in the management of hypertension forms the centre piece of the proposal and is the most significant cost of all the work streams.