BPD-Screen V1.0 05.11.18
Research type
Research Study
Full title
Blood Pressure Drug Screening in older people: a feasibility study
IRAS ID
253755
Contact name
James Sheppard
Contact email
Sponsor organisation
University of Oxford / Research Governance, Ethics & Assurance
Duration of Study in the UK
1 years, 5 months, 30 days
Research summary
Summary of Research
The population is ageing and the number of people living with age-related chronic conditions is increasing. Polypharmacy (multiple drug prescriptions) is common in older persons, and associated with increased risk of adverse drug reactions and frequent inappropriate prescribing. Polypharmacy and adverse events can lead to partial or non-adherence to medications, particularly those prescribed for prevention of disease (such as blood pressure lowering drugs).
Identifying non-adherence to treatment can be difficult, with most approaches found to be unreliable. However, methods have recently been developed at the University of Leicester using biochemical analysis to detect antihypertensives in an individual’s urine. Most studies utilising this approach have enrolled complex hypertensive patients from clinics where individuals have been referred due to suspected non-adherence or suboptimal blood pressure control. It is unclear whether medication adherence rates seen in these complex patients are representative of those in the general population presenting in primary care.
The present study will investigate whether it is feasible to collect at least 200 urine samples in a primary care setting and analyse them using this new biochemical analysis method to detect adherence to blood pressure medication in hypertensive patients, aged 65 years and over. The study will inform future trials of targeted medication reduction using this new test to stratify individuals as adherent and non-adherent to therapy.
Summary of Results
New methods for identifying non-adherence to blood pressure lowering medication exist using biochemical testing to detect the number of medications in an individual’s urine. This approach has revealed high rates of previously unrecognised non-adherence to medication in hypertensive patients referred to specialist clinics in a secondary care setting. It is unclear whether the medication adherence rates seen in these complex patients are representative of those in the general population presenting in primary care. This study approached consecutive patients from five general practices in UK primary care. They were aged 65 years or older, with hypertension, and had at least one antihypertensive prescription. Participants were asked to provide a urine sample for analysis of medication adherence. We found that this novel biochemical testing for antihypertensive medication adherence is feasible in routine primary care, with two thirds of patients able to provide a sample when approached opportunistically. Amongst those participants who were able to provide a urine sample, self-reported adherence to medication did not appear to be related to biochemically determined adherence. Overall, non-adherence to antihypertensive medication was very low (<5%), in contrast to previous studies using this approach and therefore testing using this method is not recommended for widespread use in the community.
REC name
South Central - Oxford A Research Ethics Committee
REC reference
18/SC/0647
Date of REC Opinion
17 Dec 2018
REC opinion
Favourable Opinion