Dr James Frith, Clinical Senior Lecturer at Newcastle University and a Consultant Geriatrician in the Newcastle Hospitals NHS Foundation Trust, has been awarded £1.4 million from the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme to evaluate different treatments for orthostatic hypotension.
Orthostatic hypotension (OH) is a drop in blood pressure (BP) on standing up from a sitting or lying position. The drop in BP can lead to unpleasant symptoms such as dizziness, fainting and falls. It is a common problem, found in one in five older people and one in three with Parkinson’s disease, and is usually treated either through non-drug therapies and guidance (such as drinking more water, wearing compression stockings and performing muscle tensing exercises) or (less frequently) with drugs such as fludrocortisone and midodrine, but there has been very little research into what the ideal treatment approach should be.
Dr Frith will be using this HTA award to perform a clinical trial over 5 years to compare fludrocortisone and midodrine to usual care (non-drug therapies), to see which treatment performs best. The study aims to recruit 366 participants from across 20 different hospitals, who will then be randomly assigned to one of three treatment groups – usual care, fludrocortisone or midodrine. The study will measure any change in symptoms in all three groups after six months on treatment, including effects on quality of life, daily activities, falls, BP, side effects and costs to the NHS for a total of 12 months.
“A novel feature of this trial, is that after the 200th participant we will perform a provisional review of the effectiveness of the treatments. This will allow us to stop a treatment if it is ineffective and focus on the one with most potential. The results will be available in 2024 and will have a strong influence over how this condition is managed.” Dr James Frith, Chief Investigator
Supporting the next generation of research-active clinicians and academics working in the field of ageing and long-term conditions
Newcastle’s is the only Biomedical Research Centre outside the ‘golden triangle’ of London and Oxbridge to have been granted NIHR funding in three successive rounds of competition. The impact of this longer-term investment can now be seen in the research careers of colleagues like Dr Frith, who completed his PhD in 2010 in the NIHR Newcastle BRC, before being funded as an NIHR Clinician Scientist, with a focus on identifying therapies to treat orthostatic hypotension. He is currently leading a project funded by the NIHR Newcastle BRC entitled ‘Targeting the Skeletal Muscle Pump to Aid Standing in Elders with Postural Hypotension (TaSkMAStEr)’. This involves a small-scale clinical trial, looking in detail at the effectiveness of one of the non-drug therapies currently prescribed for patients with orthostatic hypotension, by asking them to perform strengthening exercises that target the calf muscle. The training and support that the Newcastle BRC has provided to Dr Frith over the last fifteen years has made an important contribution to his being in a position to lead a large-scale clinical trial that will accelerate the conversion of lab-based research into practical and meaningful benefits for patients and the healthcare system.
About the NIHR Health Technology Assessment programme
The Health Technology Assessment (HTA) Programme funds research about the clinical and cost-effectiveness and broader impact of healthcare treatments and tests for those who plan, provide or receive care from NHS and social care services.