Doctor completes major study into impact of frailty on blood pressure

A Bradford doctor and PhD researcher has completed the biggest review of its kind to investigate whether the impact of frailty should be considered when treating older patients with high blood pressure.

Dr Oly Todd led a team from the Bradford Institute for Health Research which brought together nine research studies published around the world, including 22,000 people aged over 65 with a measure of frailty, to carry out the pioneering review.

Currently, as one of the Bradford research participants in the study said, “different doctors have different rules” on how to treat blood pressure in later life. However, Dr Todd hopes the results of his study will help define future treatment guidelines for clinicians from this vulnerable group.

Dr Todd, who is also a specialist registrar in Geriatric Medicine at Bradford Royal Infirmary, said: “We see a lot of people coming into A&E because of the complications of low blood pressure.

“Lowering blood pressure too much can lead to a lack of blood supply to the brain causing dizziness or a fall, increasing the risk of a broken bone which can be catastrophic for an older person.”

Many patients with high blood pressure are given medication to bring it down, with more than half of UK residents aged over 80 currently prescribed two or more medicines for high blood pressure.

Blood pressure

However, one in 10 people of any age also develop side effects from blood pressure medication which can be particularly dangerous to older patients with frailty.

The people used in Dr Todd’s study were selected because they matched key characteristics of patients from Bradford. The study found in people with no signs of frailty, lower blood pressure was linked to less chance of dying, whatever their age. However, for those patients with frailty, lower blood pressure was not associated with a difference in mortality.

Unfortunately, studies had not looked at the association between blood pressure and other outcomes such as measures of quality of life. In this context the authors recommend that the blood pressure of each person with frailty be considered in the context of their individual circumstances.

In time, Dr Todd and his colleagues hope a better evidence base can be developed – looking in greater depth at more specific outcomes for this population of older adults to deliver better evidence for their best care.

The study was recently published in the international peer-reviewed journal ‘Age and Ageing’, and Dr Todd hopes it will help inform the next revision of NICE guidelines on the treatment of older people with high blood pressure.

International study

Dr Todd is also leading a second, larger international study which is examining the same question. Funded by the Dunhill Medical Trust, it aims to take advantage of so-called ‘Big Data’ routinely collected by the NHS via anonymous GP records.

This work is the result of close collaboration with cardiology researchers at the University of Oxford, and frailty researchers at Dalhousie University, Canada.

Dr Todd added: “Nearly all the trials we currently have are based on people who are fit and have little in the way of medical problems other than high blood pressure.

“We don’t have evidence drawn from elderly people who live with multiple problems, despite the fact that such people represent the majority of our patients. We need to change this.

“Older people are now living longer than before and we simply don’t have enough evidence to inform their best care.”

The availability of big data also opens up research across the course of a patient’s lifetime, and may help answer questions which cannot be answered by clinical trials, which often focus on a single condition.

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Picture caption: Dr Oly Todd with some of his fellow researchers, including a patient and public representative from the study.



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  1. Bradford Teaching Hospitals NHS Foundation Trust:

Bradford Teaching Hospitals NHS Foundation Trust is responsible for providing hospital services for the people of Bradford and communities across Yorkshire. We serve a core population of around 500,000 and provide specialist services for 1.1 million people.

Our 5,500 staff work over several sites, including Bradford Royal Infirmary, which provides the majority of inpatient services, and St Luke’s Hospital, which predominantly provides outpatient and rehabilitation services. We also manage local community hospitals at Westwood Park, Westbourne Green, and Eccleshill.

In early 2017, a new £28 million wing opened at Bradford Royal Infirmary, part of a £75m investment to improve patient care across our hospitals over a five-year period. It provides world-class facilities for elderly care, children’s services, a state-of-the-art intensive care unit with increased single-room provision and a retail concourse.

The new wing is a continuation of our work to improve patient experience after our new £2 million neonatal unit officially opened in January 2015. Our maternity services were recently shortlisted for the Royal College of Midwives’ (RCM) Midwifery Service of the Year Award, recognising excellence and innovation in the provision of maternity care.

In 2017, we also completed a £2m refurbishment of our Emergency Department (ED) as part of an ambitious vision to create a more efficient acute medicine service for the people of Bradford. It has been designed to provide a slicker and more efficient service, with faster senior clinical involvement at an early stage in the patient pathway.

As a teaching hospital, we are at the forefront of education and development in healthcare, and have an excellent reputation for research performance. We are one of the leading centres in conducting applied research in the country, particularly in quality and safety, elderly care and rehabilitation.

The Trust is home to the Bradford Institute for Health Research (BIHR) where researchers have led the development, validation and implementation of the award-winning Bradford Electronic Frailty Index (eFI) which helps calculate an elderly person’s risk of disability, impairment, falls and complications of chronic diseases, as well as their diminishing independence and capability. This is now being used by 98% of all GPs across the country.

Our award-winning Ophthalmology department is home to numerous worldwide clinical trials taking the lead in eye care research and we are one of only three sites in the United Kingdom to be enlisted in the Perioperative Enhanced Recovery Hip Fracture Care of Patients with Dementia (PERFECTED) study, which will investigate how the NHS can introduce better standards of care to improve outcomes for people with dementia.

The Trust has its own Bradford Hospitals Charity:

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  1. Born in Bradford (BiB) 2019

Born in Bradford is one of the biggest and most important health research studies undertaken in the UK. The project started in 2007 and is looking to answer questions about the city’s health by tracking the lives of over 13,500 children and their families from across the city.

The aim of Born in Bradford is to find out more about why some families stay healthy and others fall ill by studying children and their families from all cultures and backgrounds as their lives unfold. It provides vital research information for studies across the UK and around the world.

Bradford has some of the highest rates of childhood illness in the UK. Born in Bradford is helping to unravel the reasons for this ill health and bringing new scientific discovery to the world. It is also providing a catalyst for communities to work with the NHS and local authority to improve child health and wellbeing in the city.

Examples of the success of Born in Bradford in changing practice include the establishment of a Yorkshire-wide congenital anomalies register, the first hospital in the UK to provide gestational diabetes screening for all pregnant women in the district, major improvement in vitamin D supplementation in high risk mothers, rapid implementation of NICE guidelines in midwifery practice, improved detection of childhood obesity by health visitors, and development of a simple mobile phone app to help parents and health professionals monitor children’s weight. Its findings on the effect of air quality on health have been used by the City’s council to lobby for investment to refurbish some of the city’s most polluting buses.

Born in Bradford will continue to follow the children, and their families, until they are adults, and help doctors to understand more about the big health challenges of the 21st Century such as heart disease, mental health and cancer. The Born in Bradford project has the potential to promote real change at a local level and also make major contributions to global knowledge: our children may be born in Bradford, but they will change the world.

Born in Bradford is led by Professor John Wright and Dr Rosie McEachan and the research team is based at the Bradford Institute for Health Research at Bradford Royal Infirmary.

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