STanding blood pressure and its AssociatioN with cardiovascular Disease and aDverse events (STANDD)

by Dr Sinead McDonagh, NIHR SPCR Research Fellow, Exeter University

The STANDD study is funded by the NIHR School for Primary Care Research (FR8 - Project No. 682). It is led by Dr Jane Masoli and Associate Professor James Sheppard and brings together a vibrant team of researchers from the Universities of Exeter, Oxford and Bristol, and public advisors from Devon and Somerset. STANDD aims to understand more about standing blood pressure and the risk of having future health problems, such as a heart attack, stroke or falling over.

Why are we doing this research?

Blood pressure measurement is a common test used in healthcare. Having high blood pressure can cause health problems, such as heart attacks and strokes.

However, when some people stand up, their blood pressure can go down. This drop in blood pressure can make people feel dizzy and sometimes fall over. Falls can result in broken bones and time spent in hospital. This low blood pressure on standing affects 1-in-5 people, even if they have high blood pressure, and is more common in older people.

Blood pressure is normally measured while people are sitting down. If blood pressure is found to be high, then medication might be recommended to lower it. Some experts worry that lowering blood pressure using medication in people who feel dizzy or fall when standing up might make this problem worse. Because of this, medical guidelines recommend that blood pressure should also be measured standing up. At the moment, there is very little scientific evidence on whether standing blood pressure compared to sitting blood pressure can help to understand the risk of having health issues, such as a stroke or heart attack. The guidelines recommend treating to standing blood pressure values in people with symptoms, such as dizziness or falls, and a lower blood pressure on standing. There have not been research studies to support this approach.

It is important to get the balance right between treating high blood pressure and not letting blood pressure drop so low on standing up that people feel dizzy or fall over.

What is the aim of the research?

The aim of this study is to find out if blood pressure measured in patients whist standing up can tell us about the future risk of having heart attacks, strokes or falls.

What will we do?

This study has two work streams. In the first work stream, we will combine existing data from multiple research studies from around the world into one dataset. These studies include health information for over 15,000 people, including sitting and standing blood pressure measurements and records of health problems such as heart attacks, strokes, falls and time spent in hospital. Using data from existing studies to answer our research questions is a much easier, quicker and cheaper approach than recruiting participants to a new research study. It also makes good use of existing research. We will analyse the information in this dataset to find out how standing and sitting blood pressures are associated with health problems in older people.

In the second work stream, we will search the literature for more research studies that have similar health information to the studies that we have already identified. In the future, we will combine the data from any newly identified studies from our literature search with existing studies so that we can examine this problem in even more detail using a larger dataset.

How will this make a difference?

The results of this research will help to guide more individual blood pressure treatment decisions in people with a drop in blood pressure when they stand up; this will help reduce the risk of patients having heart attacks, strokes and falls.

We will work with our public advisors throughout the project to ensure that the work undertaken is sensitive to the needs of individuals with blood pressure problems. We will disseminate findings in key research journals and at national and international conferences, as well as via websites, social media and through liaising with local and national societies (such as the British and Irish Hypertension Society) and patient facing platforms (such as Blood Pressure UK, National Voices and the National Association for Patient Participation).

Reblogged with permission from Collaboration for Academic Primary Care (APEx) Blog (University of Exeter)