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dc.contributor.authorSheppard, James P
dc.contributor.authorStevens, Sarah
dc.contributor.authorStevens, Richard J
dc.contributor.authorMant, Jonathan
dc.contributor.authorMartin, Una
dc.contributor.authorHobbs, FD Richard
dc.contributor.authorMcManus, Richard J
dc.date.accessioned2018-11-08T00:30:21Z
dc.date.available2018-11-08T00:30:21Z
dc.date.issued2018-09-05
dc.identifier.issn2044-6055
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/284731
dc.description.abstractOBJECTIVES: Evidence to support initiation of pharmacological treatment in patients with uncomplicated (low risk) mild hypertension is inconclusive. As such, clinical guidelines are contradictory and healthcare policy has changed regularly. The aim of this study was to determine the incidence of lifestyle advice and drug therapy in this population and whether secular trends were associated with policy changes. DESIGN: Longitudinal cohort study. SETTING: Primary care practices contributing to the Clinical Practice Research Datalink in England. PARTICIPANTS: Data were extracted from the linked electronic health records of patients aged 18-74 years, with stage 1 hypertension (blood pressure between 140/90 and 159/99 mm Hg), no cardiovascular disease (CVD) risk factors and no treatment, from 1998 to 2015. Patients exited if follow-up records became unavailable, they progressed to stage 2 hypertension, developed a CVD risk factor or received lifestyle advice/treatment. PRIMARY OUTCOME MEASURES: The association between policy changes and incidence of lifestyle advice or treatment, examined using an interrupted time-series analysis. RESULTS: A total of 108 843 patients were defined as having uncomplicated mild hypertension (mean age 51.9±12.9 years, 60.0% female). Patientsspent a median 2.6 years (IQR 0.9-5.5) in the study, after which 12.2% (95% CI 12.0% to 12.4%) were given lifestyle advice, 29.9% (95% CI 29.7% to 30.2%) were prescribed medication and 19.4% (95% CI 19.2% to 19.6%) were given both. The introduction of the quality outcomes framework (QOF) and subsequent changes to QOF indicators were followed by significant increases in the incidence of lifestyle advice. Treatment prescriptions decreased slightly over time, but were not associated with policy changes. CONCLUSIONS: Despite secular trends that accord with UK guidance, many patients are still prescribed treatment for mild hypertension. Adequately powered studies are needed to determine if this is appropriate.
dc.format.mediumElectronic
dc.languageeng
dc.publisherBMJ
dc.rightsAttribution 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectHumans
dc.subjectHypertension
dc.subjectAntihypertensive Agents
dc.subjectMedical Record Linkage
dc.subjectLongitudinal Studies
dc.subjectLife Style
dc.subjectDirective Counseling
dc.subjectBlood Pressure
dc.subjectHealth Policy
dc.subjectAdult
dc.subjectMiddle Aged
dc.subjectPrimary Health Care
dc.subjectQuality of Health Care
dc.subjectEngland
dc.subjectFemale
dc.subjectMale
dc.subjectPractice Guidelines as Topic
dc.subjectElectronic Health Records
dc.subjectInterrupted Time Series Analysis
dc.titleAssociation of guideline and policy changes with incidence of lifestyle advice and treatment for uncomplicated mild hypertension in primary care: a longitudinal cohort study in the Clinical Practice Research Datalink.
dc.typeArticle
prism.issueIdentifier9
prism.publicationDate2018
prism.publicationNameBMJ Open
prism.startingPagee021827
prism.volume8
dc.identifier.doi10.17863/CAM.32103
dcterms.dateAccepted2018-07-25
rioxxterms.versionofrecord10.1136/bmjopen-2018-021827
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.licenseref.startdate2018-09-05
dc.contributor.orcidSheppard, James P [0000-0002-4461-8756]
dc.contributor.orcidStevens, Sarah [0000-0003-1094-8455]
dc.contributor.orcidStevens, Richard J [0000-0002-9258-4060]
dc.contributor.orcidMant, Jonathan [0000-0002-9531-0268]
dc.contributor.orcidMcManus, Richard J [0000-0003-3638-028X]
dc.identifier.eissn2044-6055
rioxxterms.typeJournal Article/Review
cam.issuedOnline2018-09-05


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Attribution 4.0 International
Except where otherwise noted, this item's licence is described as Attribution 4.0 International