Trends in the diagnosis and management of hypertension:repeated primary care survey in South West England e306 British Journal of General Practice, May 2017 UK, from 18 January 2016 as an online (SurveyMonkey ® ) questionnaire. Invitations to participate were first sent in an e-mail with a link to the survey to all practices registered with the Clinical Research Network. Similar invitations were then included in the electronic newsletters of Cornwall, Devon, and Somerset local medical committees to all practices across the three counties; reminders were sent in the newsletters 2 months later. The paper version of the questionnaire was distributed to delegates attending a clinical research network meeting in early 2016, and in June the paper questionnaire was posted with a reply paid envelope to the managers of all non-responding practices, with a request to pass to the practice hypertension lead. Data collection was completed at the end of July 2016. Sample sizeThis was a follow-up survey so no formal sample size calculation was performed. AnalysisData from replies were collated on an Excel spreadsheet with the published data from the QOF year ending March 2015. QOF provides individual practice-level data on list size, numbers with hypertension (the hypertension register), and practice prevalence for hypertension. The QOF contract sets a blood pressure target of ≤150/90 mmHg to be achieved for 80% or more patients on the register; individuals can be excepted from this target where it is deemed clinically inappropriate or they do not attend for care. Consequently, the QOF data include both an unadjusted target achievement rate using the denominator of all patients on the hypertension register (the raw achievement), and an adjusted achievement rate where excepted patients are omitted from the calculation (the net achievement). Numbers and rates for exception reporting are also provided for all practices. 16 Where duplicate responses were received from a practice, the most complete version was entered, or, if both were complete, the first reply received. Anonymous responses were included in the reported survey findings but not in analyses by location or outcome QOF data.Variations in QOF data were explored with Pearson's correlation coefficients, and characteristics of responding and non-responding practices were compared using t-tests or χ 2 tests as appropriate to the data. Trends in proportions across the three surveys were tested with the extended Mantel-Haenszel χ 2 for linear trend, and comparisons of QOF outcome data with organisational factors were made using t-tests. RESULTS ResponsesThe questionnaire was distributed to all 305 practices in Cornwall, Devon, and Somerset, and 117 individual practice responses were received (38% response rate). Response rates in 2007 and 2010 were 31% and 34%, respectively (P = 0.24 for trend).9 Sixteen replies were anonymous so could not be linked to QOF outcome data, but were included in the survey findings. How this fits inPrevious surveys have suggested a shift from GP t...

Background Postural hypotension (PH), the reduction in blood pressure when rising from sitting or lying 0to standing, is a risk factor for falls, cognitive decline and mortality. However, it is not often tested for in primary care. PH prevalence varies according to definition, population, care setting and measurement method. The aim of this study was to determine the prevalence of PH across different care settings and disease subgroups. Methods Systematic review, meta-analyses and meta-regression. We searched Medline and Embase to October 2019 for studies based in primary, community or institutional care settings reporting PH prevalence. Data and study level demographics were extracted independently by two reviewers. Pooled estimates for mean PH prevalence were compared between care settings and disease subgroups using random effects meta-analyses. Predictors of PH were explored using meta-regression. Quality assessment was undertaken using an adapted Newcastle-Ottawa Scale. Results One thousand eight hundred sixteen studies were identified; 61 contributed to analyses. Pooled prevalences for PH using the consensus definition were 17% (95% CI, 14–20%; I2 = 99%) for 34 community cohorts, 19% (15–25%; I2 = 98%) for 23 primary care cohorts and 31% (15–50%; I2 = 0%) for 3 residential care or nursing homes cohorts (P = 0.16 between groups). By condition, prevalences were 20% (16–23%; I2 = 98%) with hypertension (20 cohorts), 21% (16–26%; I2 = 92%) with diabetes (4 cohorts), 25% (18–33%; I2 = 88%) with Parkinson’s disease (7 cohorts) and 29% (25–33%, I2 = 0%) with dementia (3 cohorts), compared to 14% (12–17%, I2 = 99%) without these conditions (P < 0.01 between groups). Multivariable meta-regression modelling identified increasing age and diabetes as predictors of PH (P < 0.01, P = 0.13, respectively; R2 = 36%). PH prevalence was not affected by blood pressure measurement device (P = 0.65) or sitting or supine resting position (P = 0.24), however, when the definition of PH did not fulfil the consensus description, but fell within its parameters, prevalence was underestimated (P = 0.01) irrespective of study quality (P = 0.04). Conclusions PH prevalence in populations relevant to primary care is substantial and the definition of PH used is important. Our findings emphasise the importance of considering checking for PH, particularly in vulnerable populations, to enable interventions to manage it. These data should contribute to future guidelines relevant to the detection and treatment of PH. PROSPERO:CRD42017075423.

Background: Postural hypotension (PH), the reduction in blood pressure when rising from sitting or lying to standing, is a risk factor for falls, cognitive decline and mortality. However, it is not often tested for in primary care. PH prevalence varies according to definition, population, care setting and measurement method. The aim of this study was to determine the prevalence of PH across different care settings and disease subgroups. Methods: Systematic review, meta-analyses and meta-regression. We searched Medline and Embase to October 2019 for studies based in primary, community or institutional care settings reporting PH prevalence. Data and study level demographics were extracted independently by two reviewers. Pooled estimates for mean PH prevalence were compared between care settings and disease subgroups using random effects meta-analyses. Predictors of PH were explored using meta-regression. Quality assessment was undertaken using an adapted Newcastle-Ottawa Scale. Results: 1816 studies were identified; 61 contributed to analyses. Pooled prevalences for PH using the consensus definition were 17% (95% CI, 14-20%; I2=99%) for community cohorts, 19% (15-25%; I2=98%) for 23 primary care cohorts and 31% (15-50%; I2=0%) for 3 residential care or nursing homes cohorts (P=0.16 between groups). By condition, prevalences were 20% (16-23%; I2=98%) with hypertension (20 cohorts), 21% (16-26%; I2=92%) with diabetes (4 cohorts), 25% (18-33%; I2=88%) with Parkinson’s disease (7 cohorts) and 29% (25-33%; I2=0%) with dementia (3 cohorts), compared to 14% (12-17%; I2=99%) without these conditions (P<0.01 between groups). Multivariable meta-regression modelling identified increasing age and diabetes as predictors of PH (P<0.01, P=0.13, respectively; R2=36%). PH prevalence was not affected by blood pressure measurement device (P=0.65) or sitting or supine resting position (P=0.24), however, when the definition of PH did not fulfil the consensus description, but fell within its parameters, prevalence was underestimated (P=0.01) irrespective of study quality (P=0.04). Conclusions: PH prevalence in populations relevant to primary care is substantial and the definition of PH used is important. Our findings emphasise the importance of considering checking for PH, particularly in vulnerable populations, to enable interventions to manage it. These data should contribute to future guidelines relevant to the detection and treatment of PH. PROSPERO:CRD42017075423.

Background: Postural hypotension (PH), the reduction in blood pressure when rising from sitting or lying to standing, is a risk factor for falls, cognitive decline and mortality. However, it is not often tested for in primary care despite these associated risks. PH prevalence varies according to definition, population, care setting and measurement method. The aim of this study was to determine the prevalence of PH across different care settings and disease subgroups.Methods: A systematic review, meta-analyses and meta-regression were undertaken. We searched Medline and Embase to October 2019 for studies based in primary, community or institutional care settings reporting PH prevalence. Data and study level demographics were extracted independently by two reviewers. Pooled estimates for mean prevalence of PH were compared between care settings and disease subgroups using random effects meta-analyses. Predictors of PH were explored using meta-regression. Quality assessment of included studies was undertaken using an adapted version of the Newcastle-Ottawa Scale.Results: 1816 studies were identified; 61 contributed to analyses. Pooled prevalences for PH using the consensus definition were 17% (95% CI, 14-20%) in the community, 19% (15-25%) in primary care and 31% (15-50%) in residential care or nursing homes (P=0.16 between groups). By condition, prevalences were 20% (16-24%) with hypertension, 21% (16-26%) with diabetes, 25% (18-33%) with Parkinson’s disease and 29% (25-33%) with dementia, compared to 14% (12-17%) without these conditions (P<0.01 between groups). Multivariable meta-regression modelling identified increasing age and diabetes as predictors of PH (P<0.01, P=0.13, respectively; R2=36%). PH prevalence was not affected by blood pressure measurement device (P=0.65) or sitting or supine resting position (P=0.24), however, when the definition of PH did not fulfil the consensus description, but fell within its parameters, prevalence was underestimated (P=0.01) irrespective of study quality (P=0.04).Conclusions: The prevalence of PH in populations relevant to primary care is substantial. The definition used is important when testing for PH. Our findings emphasise the importance of considering checking for PH, particularly in vulnerable populations, to enable interventions to manage it. These data should contribute to future guidelines relevant to the detection and treatment of postural hypotension.PROSPERO: CRD42017075423.