Grant: Operating Grant: SPOR Innovative Clinical Trial Multi-Year Grant

High blood pressure (present in 1 out of every 5 Canadian adults) increases the risk of heart attacks and strokes. Blood pressure lowering pills reduce this risk - but we may not be using these drugs optimally. A study conducted in Spain suggests that using blood pressure pills at BEDTIME, instead of taking them in the morning (when they are most commonly used), reduces death, heart attack, and stroke by more than 50%. If true, a switch to bedtime prescribing would have more impact on the health of Canadians with high blood pressure than whether high blood pressure is treated at all - increasing life expectancy an estimated 5.5 years. Surprisingly, this study has yet to change how high blood pressure is treated. This is because 1) many health care providers feel it is "too good to be true" (i.e. don't know if they can believe it) and 2) because the RISKS of bedtime blood pressure lowering haven't been explored. Examples of potential risks include more falls and fractures in older adults who might feel lightheaded late at night, and worsening of vision in patients who are at risk of glaucoma. In this project, volunteer patients and their primary care providers will be conducting a large treatment trial designed to 1) establish whether heart attacks and strokes really are reduced by switching blood pressure medications to bedtime, and 2) determine who might be put at risk if the timing of blood pressure pills changes. In pursuit of answers to these pivotal questions we will 1) leverage 7 electronic health databases spanning three provinces, 2) introduce new technology that will assist the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) to conduct clinical trials, and 3) expand the reach of the Pragmatic Trials Collaborative (Canada's largest practice-based research network www.PragmtaticTrials.ca). The BedMed trial will forge a novel tri-provincial pragmatic trials network and serve as a template for future comparative effectiveness work.