What are the future risks for younger people with high blood pressure?

20 October 2022

 

High blood pressure is linked to a range of adverse outcomes, including strokes and heart attacks. We have a range of different tools that can be used to identify the risk of such events over the next five to ten years, but these are mainly used in older people.

Building upon work that has been done in people aged 65 and over, we are interested in testing a different approach to risk assessment in people aged 18-64. Whereas traditional cardiovascular risk assessment tools typically rely upon counting a number of risk factors linked to heart disease (such as diabetes and smoking), the approach we are interested in testing out looks at a much wider range of risk factors, accumulated over a person’s lifetime. In older people, we refer to this as a frailty index. It assesses for the presence of a wide range of so-called deficits – typically 30-50 different factors, and the more of these that are present, the greater the risk. In older people, the frailty index has been linked to a wide range of adverse outcomes such as falls, fractures, admission to hospital and admission to care homes.

We don’t know if the frailty index would work in younger people, if people aged 18-64 will be interested in knowing their risks, nor what outcomes might be relevant, so we are interested in hearing your views. You don’t have be a health professional or have high blood pressure to take part. You just need to be an adult aged 18-64.

The study is just getting started, but we are keen to hear from you soon, so that your views and perspectives can help shape the research, such that its findings are relevant and meaningful. We can arrange face to face or virtual discussions and can cover your expenses and offer a small honorarium for your time. You will find more information on our plans below. 

You can contact the study team via e-mail in the first instance if you would like to be involved: .conroy@ucl.ac.uk Thank you in advance for your interest.

 

Simon Conroy

Consultant Geriatrician, St Pancras Hospital, Central and North West London NHS Foundation Trust 

Honorary Professor of Geriatric Medicine, MRC Unit for Lifelong Health and Ageing at UCL

Honorary Consultant Geriatrician, University College Hospitals London

Study summary

Frailty refers to a person’s mental and physical ability to bounce back and recover from illness or injury. Frailty is widely used to guide the clinical care of older people. However, its relevance in people aged under 65 is not clear. This research will examine different approaches to frailty measurement in younger people. We will see if we can apply these measurements across the NHS. The aim is to identify the risk of future poor outcomes, such as changes in physical health or quality of life, to direct earlier care and treatment.

We will use national studies which have followed people since birth, to make a ‘frailty index’. This is a way of measuring the level of frailty and it can be applied to different groups of people over time. These work by identifying common factors associated with frailty and determining how many are present in any given individual. This results in a frailty index, higher scores of which are linked to adverse outcomes in older people. The birth cohorts allow us to look at factors across people’s lives (e.g. socioeconomic position), which may influence frailty at any age.

At the same time, we will test a Hospital Frailty Risk Score (HFRS), created automatically from NHS electronic records for people admitted to hospital in England. We will examine if this risk score is related to hospital outcomes such as long stays and survival.

The frailty index and the HFRS will be linked to NHS electronic records in the same people. We can then see how the two different approaches to frailty measurement compare, for the available outcomes.

Once we understand the factors associated with frailty in younger adults, we can think about polices or interventions that could be applied during a person’s life to slow or prevent the development of frailty.

To inform and support this work, we will engage with lay and professional stakeholders with an interest in frailty in younger ages. Together, we will consider which changes in health or quality of life are meaningful to younger people with a range of long-term conditions. Using their perspectives on experiencing frailty earlier in adulthood, we will ensure our research is capturing what’s important, and that it will be useful.

There will be widespread communication of the findings through lay briefings, a YouTube video, podcasts, and academic papers. In addition, we have strong links to national networks (including the NHS director for health inequalities) that are well placed to put the results of this work into practice.