Richard Stevens's research while affiliated with University of Oxford and other places

Publications (200)

Article
Syncope is one of the most common side effects associated with antihypertensive medication. In patients at increased of syncope, the additional risk of harm from antihypertensive medication may outweigh the potential benefits of treatment in terms of cardiovascular risk reduction. However, it is unclear how to identify patients at most risk of sync...
Article
Antihypertensives are effective at reducing the risk of cardiovascular disease, but limited data exist quantifying their association with serious adverse events (SAEs), particularly in older people with frailty. This study examined this association using data from a large database of electronic health records. This was a retrospective observational...
Article
Falls are one of the most common side effects associated with antihypertensive medication. In patients at high risk of falls, the additional risk of harm from medication may outweigh the potential benefits in terms of cardiovascular risk reduction. However, it is currently unclear which patients are at high risk of falls. This study aimed to develo...
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Objective: To determine the accuracy of self-testing for proteinuria during pregnancy. Design: Diagnostic accuracy study. Setting: Antenatal clinics, maternity assessment units, and inpatient wards at three hospital sites. Population or sample: 345 pregnant women. Methods: Pregnant women self-tested in-clinic for urinary protein using visu...
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Objectives: The aim was to investigate the impact of a group-based weight management programme on symptoms of depression and anxiety compared with self-help in a randomised controlled trial (RCT). Method: People with overweight (Body Mass Index [BMI]≥28kg/m2) were randomly allocated self-help (n = 211) or a group-based weight management programm...
Article
Introduction: The UK Medicines and Healthcare products Regulatory Agency (MHRA) has published frequent summaries of spontaneous reports of suspected adverse drug reactions (ADRs) (Yellow Cards) to vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The EudraVigilance database has provided similar data for the European Ec...
Article
Background Long-term monitoring is important in chronic condition management. Despite considerable costs of monitoring, there is no or poor evidence on how, what and when to monitor. The aim of this study was to improve understanding, methods, evidence base and practice of clinical monitoring in primary care, focusing on two areas: chronic kidney d...
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Background Reducing meat consumption could bring health and environmental benefits, but there is little research to date on effective interventions to achieve this. A non-randomised controlled intervention study was used to evaluate whether prominent positioning of meat-free products in the meat aisle was associated with a change in weekly mean sal...
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Objective To assess the associations between statins and adverse events in primary prevention of cardiovascular disease and to examine how the associations vary by type and dosage of statins. Design Systematic review and meta-analysis. Data sources Studies were identified from previous systematic reviews and searched in Medline, Embase, and the C...
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Background: Monitoring is the mainstay of chronic kidney disease management in primary care. There is little evidence on how best to monitor. Aim: To compare the effectiveness of eGFR derived from creatinine or cystatin C, to predict renal function decline among those with a recent eGFR of 30-89 ml/min/1.73m². Design and setting: Observational...
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There has been a marked rise in the number of avoidable deaths in health services around the world. At the same time there has been a growing increase in antibiotic resistant so-called “superbugs.” We examine here the potential role of body temperature measurement in these adverse trends. Electronic based thermometers have replaced traditional merc...
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Objective To examine the association between antihypertensive treatment and specific adverse events. Design Systematic review and meta-analysis. Eligibility criteria Randomised controlled trials of adults receiving antihypertensives compared with placebo or no treatment, more antihypertensive drugs compared with fewer antihypertensive drugs, or h...
Article
Objective To evaluate design, methods, and reporting of impact studies of cardiovascular clinical prediction rules (CPRs). Study Design and Setting We conducted a systematic review. Impact studies of cardiovascular CPRs were identified by forward citation and electronic database searches. We categorized the design of impact studies as appropriate...
Article
Objective: To understand the current prevalence of, and attitudes to, self-monitoring of blood pressure (BP) during pregnancy. Methods: Five thousand, five hundred and fifty-five pregnant women from antenatal clinics in 16 hospitals in England were invited to complete a survey. Main outcome measures: The primary outcome was the proportion of w...
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Background In 2011, National Institute for Health and Care Excellence (NICE) guidelines recommended the routine use of out-of-office blood pressure (BP) monitoring for the diagnosis of hypertension. These changes were predicted to reduce unnecessary treatment costs and workload associated with misdiagnosis. Aim To assess the impact of guideline ch...
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Background People with reduced kidney function have increased cardiovascular disease (CVD) risk. We present a policy model that simulates individuals' long-term health outcomes and costs to inform strategies to reduce risks of kidney and CVDs in this population.Methods and findingsWe used a United Kingdom primary healthcare database, the Clinical P...
Article
Background: Clinical prediction rules (CPRs) can help general practitioners (GPs) address challenges in cardiovascular disease. A survey published in 2014 evaluated GPs' awareness and use of CPRs in the UK. However, many new CPRs have been published since and it is unknown which cardiovascular CPRs are currently recognised and used. Aim: To iden...
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Background Home blood-pressure (BP) monitoring is recommended in guidelines and is increasingly popular with patients and health professionals, but the accuracy of patients’ own monitors in real-world use is not known. Aim To assess the accuracy of home BP monitors used by people with hypertension, and to investigate factors affecting accuracy. D...
Article
Research objective To determine if Muscle Response Testing (MRT) can be used to distinguish lies from truths using blind test patients. Design A prospective study of diagnostic test accuracy was carried out using MRT to distinguish lies from truth. Methods Twenty practitioners who routinely practised MRT were paired with 20 blind test patients (T...
Article
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In recent years, national and international guidelines have recommended the use of out-of-office blood pressure monitoring for diagnosing hypertension. Despite evidence of cost-effectiveness, critics expressed concerns this would increase cardiovascular morbidity. We assessed the impact of these changes on the incidence of hypertension, out-of-offi...
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Background and objectives: Definitions of calibration, an aspect of model validation, have evolved over time. We examine use and interpretation of the statistic currently referred to as the calibration slope. Methods: The history of the term "calibration slope", and usage in papers published in 2016 and 2017, were reviewed. The behaviour of the...
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Background: Evidence for kidney function monitoring intervals in primary care is weak, and based mainly on expert opinion. In the absence of trials of monitoring strategies, an approach combining a model for the natural history of kidney function over time combined with a cost-effectiveness analysis offers the most feasible approach for comparing t...
Conference Paper
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Objectives Previous research shows that the terminology ‘chronic kidney disease’ (CKD) is problematic for both patients and general practitioners, arguably because it represents an ageing process rather than a disease. We have previously proposed an alternative terminology ‘kidney age’ to supersede the terminology of CKD stages 2, 3a, 3b and 4. We...
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Objectives To characterise serum creatinine and urinary protein testing in UK general practices from 2005 to 2013 and to examine how the frequency of testing varies across demographic factors, with the presence of chronic conditions and with the prescribing of drugs for which kidney function monitoring is recommended. Design Retrospective open coh...
Article
Background: Blood pressure (BP) measurement is increasingly carried out through home or ambulatory monitoring, yet existing cardiovascular risk scores were developed for use with measurements obtained in clinics. Aim: To describe differences in cardiovascular risk estimates obtained using ambulatory or home BP measurements instead of clinic read...
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Introduction: Muscle response testing (MRT) is an assessment method used by 1 million practitioners worldwide, yet its usefulness remains uncertain. The aim of this study, one in a series assessing the accuracy of MRT, was to determine whether emotionally arousing stimuli influence its accuracy compared to neutral stimuli. Methods: To assess dia...
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Background: Self-monitoring of blood pressure better predicts prognosis than clinic measurement, is popular with patients, and endorsed in hypertension guidelines. However, there is uncertainty over the optimal self-monitoring schedule. We therefore aimed to determine the optimum schedule to predict future cardiovascular events and determine "true...
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Purpose Overlooking other medical conditions during cancer treatment and follow-up could result in excess morbidity and mortality, thereby undermining gains associated with early detection and improved treatment of cancer. We compared the quality of care for diabetes patients subsequently diagnosed with breast, colorectal, or prostate cancer to mat...
Article
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Importance Evidence to support initiation of pharmacologic treatment in low-risk patients with mild hypertension is inconclusive, with previous trials underpowered to demonstrate benefit. Clinical guidelines across the world are contradictory. Objective To examine whether antihypertensive treatment is associated with a low risk of mortality and ca...
Article
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Introduction Hypertensive disorders during pregnancy result in substantial maternal morbidity and are a leading cause of maternal deaths worldwide. Self-monitoring of blood pressure might improve the detection and management of hypertensive disorders of pregnancy but few data are available, including regarding appropriate thresholds. Objective Thi...
Article
Objectives: Blood pressure (BP) is a long-established risk factor for cardiovascular disease (CVD). SBP is used in all widely used cardiovascular risk scores for clinical decision-making. Recently, within-person BP variability has been shown to be a major predictor of CVD. We investigated whether cardiovascular risk scores could be improved by inc...
Article
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Hypertensive disorders during pregnancy result in substantial maternal morbidity and are a leading cause of maternal deaths worldwide. Self-monitoring of blood pressure (BP) might improve the detection and management of hypertensive disorders of pregnancy, but few data are available, including regarding appropriate thresholds. This systematic revie...
Article
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Objectives Evidence to support initiation of pharmacological treatment in patients with uncomplicated (low risk) mild hypertension is inconclusive. As such, clinical guidelines are contradictory and healthcare policy has changed regularly. The aim of this study was to determine the incidence of lifestyle advice and drug therapy in this population a...
Article
Several philosophers of medicine have attempted to answer the question “what is disease?” In current clinical practice, an umbrella term “chronic kidney disease” (CKD) encompasses a wide range of kidney health states from commonly prevalent subclinical, asymptomatic disease to rare end‐stage renal disease requiring transplant or dialysis to support...
Article
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Background Competing risks occur when populations may experience outcomes that either preclude or alter the probability of experiencing the main study outcome(s). Many standard survival analysis methods do not account for competing risks. We used mortality risk in people with diabetes with and without albuminuria as a case study to investigate the...
Data
Supplementary information: figures 1-3, extended methods, tables 1-8, statistical analysis plan, and references
Article
Objective: To prospectively validate the Predicting Out-of-OFfice Blood Pressure (PROOF-BP) algorithm to triage patients with suspected high blood pressure for ambulatory blood pressure monitoring (ABPM) in routine clinical practice. Design: Prospective observational cohort study. Setting: 10 primary care practices and one hospital in the UK....
Article
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Objective To prospectively validate the Predicting Out-of-OFfice Blood Pressure (PROOF-BP) algorithm to triage patients with suspected high blood pressure for ambulatory blood pressure monitoring (ABPM) in routine clinical practice. Design Prospective observational cohort study. Setting 10 primary care practices and one hospital in the UK. Parti...
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Background: Recurrent mood episodes and subsyndromal mood instability cause substantial disability in patients with bipolar disorder. Early identification of mood episodes enabling timely mood stabilization is an important clinical goal. This study investigates the ability of control chart methodology to predict manic and/or depressive episodes by...
Article
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Objectives Hypertension trials and epidemiological studies use multiple clinic blood pressure (BP) measurements at each visit. Repeat measurement is also recommended in international guidance; however, little is known about how BP is measured routinely. This is important for individual patient management and because routinely recorded readings form...
Article
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Objectives UK primary care databases (PCDs) are used by researchers worldwide to inform clinical practice. These databases have been primarily tied to single clinical computer systems, but little is known about the adoption of these systems by primary care practices or their geographical representativeness. We explore the spatial distribution of cl...
Article
OBJECTIVES: UK primary care databases (PCDs) are used by researchers worldwide to inform clinical practice. These databases have been primarily tied to single clinical computer systems, but little is known about the adoption of these systems by primary care practices or their geographical representativeness. We explore the spatial distribution of c...