Optimising blood pressure management for older people with frailty


Objectives and brief methodology

We know that tight blood pressure control in young and middle age reduces future stroke and heart attack risk.  We don’t know if therapy is as effective for frail older people as they have been excluded from large clinical trials. Yet there is growing evidence that in some of the frail elderly, treatment may do harm.

Current practice focuses just on BP as a number. But clearly there are trade-offs: sacrificing short term adverse effects for long term vascular risk prevention. Considering frailty could inform treatment.

We need to know whether and how frailty modifies BP management on the net effect on quality of life, independent living and mortality.

The overarching aim of this fellowship is to investigate the association between frailty, hypertension and clinical outcomes to inform optimisation of blood pressure management for people with well-defined frailty. This will be done through four linked studies:


Study 1 will take stock of the available literature to provide context for my primary study and to inform the type of outcomes I should be looking at.


Study 2 will involve use interviews to identify from patients and their carers emergent themes concerning studies 3 and 4.


Study 3 will apply the electronic frailty index (eFI) to large primary care data sets (approx. 1.5million older people). Here I will ascertain whether frailty has a modifying effect on the association between blood pressure and outcomes derived from Hospital episode statistics. I will use multivariable regression techniques. This analysis will be highly statistically powered, but limited in the granularity of BP and frailty measurements.

Therefore, Study 4 will use a prospective cohort highly characterized in terms of BP and frailty measures to determine whether similar patterns exist in this richer data set.

Together, the results of these 4 linked studies will provide key generalizable knowledge to inform and guide clinical decision making on the treatment of blood pressure in older people.


Outputs & Results

Wilkinson C, Todd O, Clegg A, Gale CP, Hall M. Management of atrial fibrillation for older people with frailty: a systematic review and meta-analysis. Age Ageing 2018 https://doi.org/10.1093/ageing/afy180. [Epub ahead of print]


Partners & Collaborators

Principle Investigator: Dr Oly Todd

Supervisory Team: Dr Andy Clegg (AUECR), Prof Chris Gale (LICAMM), Dr Marlous Hall (LICAMM), Ms Mary Godfrey (AUECR), Prof John Young (AUECR)


List of Collaborators

Prof Richard Mc Manus, Dr James Sheppard, Nuffield Department of Primary Care Health Sciences, University of Oxford.

Prof Kenneth Rockwood, Division of Geriatric Medicine, Dalhousie University, Halifax, Canada.

Prof Trevor Sheldon, University of York, Mentor at Bradford Institute of Health Research.



01/10/2017 – 30/09/2020


Funding agency

Dunhill Medical Trust Research Training PhD Fellowship


Further information

Follow @ToddOly on Twitter

For more information email oliver.todd@bthft.nhs.uk