Maximising medication adherence and minimising physician interia: 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.

Finally, for people who are thinking about taking part in this study, we will see if it is better to give them information on a tablet computer, rather than on printed pages.

Award Date
04 December 2020
Award Value
Principal Investigator
Professor Andrew Murphy
Host Institution
National University of Ireland, Galway
DIFA 2020