Long-term conditions
The Long-Term Conditions (LTC) theme encompasses research into all chronic conditions for which there is currently no cure, and which are managed with medications and other treatments in primary care, including both physical and mental health conditions. Particular areas of focus are cardiovascular disease, diabetes, and asthma/COPD, as well as multi-morbidity, and frailty and diseases of ageing.
Our vision is to deliver world-leading, impactful research programmes into all aspects of detection, diagnosis, care and prognosis of long-term conditions, resulting in improved health and care.
The theme brings together LTC researchers from across APEx, with expertise in a wide range of methodologies, including clinical trials, epidemiology and data science, qualitative methods, and evidence synthesis.
Aims
- To address all aspects of chronic disease management including detection (e.g. risk stratification, clinical methods), diagnosis (e.g. new diagnostic tools), care (e.g. doctor-patient communication, non-drug interventions), and prognosis (e.g. prediction tools)
- To improve health and care for people living with LTCs
- To share expertise across methodologies and clinical topics
- To prioritise research topics, co-ordinate responses to future research calls, and offer shared opportunities to enhance future funding bids
- To support career development
Theme Leadership
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Professor Rupert Payne - Co-Lead
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Associate Professor Chris Clark - Co-Lead
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Projects
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Title |
Funder |
Amount £ |
Project/ Programme/ Fellowship |
Exeter lead investigator |
Web link |
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IMPPP: Improving Medicines use in People with Polypharmacy in Primary Care |
NIHR HSDR |
£2 million |
Project |
Payne RA |
https://www.bristol.ac.uk/primaryhealthcare/researchthemes/imppp/ |
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INTERPRESS-IPD: The Inter-arm blood pressure difference Individual Patient Data Collaboration |
NIHR RfPB |
£149 K |
Project |
Clark CE |
https://medicine.exeter.ac.uk/health-community/research/primarycare/interpress-ipd/ |
Other current active projects
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Title |
Funder |
Amount £ |
Project/ Programme/ Fellowship |
Exeter lead investigator |
Project web link (if none, please state) |
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Personalised Space Technology Exercise Platform (P-STEP) |
ESA |
£2 million |
Project |
Kadam U |
https://le.ac.uk/cehs/research/personalised-space-technology-exercise-platform |
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BRISMED: Improving the quality of medication reviews in general practice |
NIHR HSDR |
£0.9 million |
Project |
Payne RA |
|
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Deprescribing in the context of limited life expectancy (D-PiLL) |
NIHR SPCR |
£148 K |
Project |
Payne RA |
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PPhoCUs: Polypharmacy, Pharmacists and Clinical Uncertainty – Understanding how pharmacist decision making can be improved in the context of polypharmacy |
NIHR SPCR/Wellcome |
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Fellowship |
Kallis T |
Other recently completed projects
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|
End date |
Funder |
Amount £ |
Project/ Programme/ Fellowship |
Exeter lead investigator |
Project web link (if none, please state) |
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IMPPP: Improving Medicines use in People with Polypharmacy in Primary Care |
Oct 2024 |
NIHR |
£2 million |
Project |
Payne RA |
https://www.bristol.ac.uk/primaryhealthcare/researchthemes/imppp/ |
Publications
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1 |
Fagbamigbe AF, Agrawal U, Azcoaga-Lorenzo A, et al. Clustering long-term health conditions among 67728 people with multimorbidity using electronic health records in Scotland. PLoS One. 2023;18(11):e0294666 |
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2 |
Clark C, Warren W, Boddy K, et al. Associations of higher versus lower arm systolic blood pressure with cardiovascular outcomes. A meta-analysis of individual participant data from the INTERPRESS-IPD Collaboration. Hypertension 2022;79:2328-2335 |
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3 |
Ling S, Sweeting M, Zaccardi F, Adlam D, Kadam UT. Glycosylated haemoglobin and prognosis in 10,536 people with cancer and pre-existing diabetes: a meta-analysis with dose-response analysis. BMC Cancer. 2022;22(1):1048 |
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4 |
Ho ISS, Azcoaga-Lorenzo A, Akbari A, et al. Measuring multimorbidity in research: Delphi consensus study. BMJ Med. 2022;1(1):e000247 |
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5 |
Sheppard JP, Burt J, Lown M, et al; OPTIMISE Investigators. Effect of Antihypertensive Medication Reduction vs Usual Care on Short-term Blood Pressure Control in Patients With Hypertension Aged 80 Years and Older: The OPTIMISE Randomized Clinical Trial. JAMA. 2020;323(20):2039-2051 |
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6 |
Payne RA, Mendonca SC, Elliott MN, et al. Development and validation of the Cambridge Multimorbidity Score. CMAJ. 2020;192(5):E107-E114 |
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7 |
Miani C, Martin A, Exley J, et al. Clinical effectiveness and cost-effectiveness of issuing longer versus shorter duration (3-month vs. 28-day) prescriptions in patients with chronic conditions: systematic review and economic modelling. Health Technol Assess. 2017;21(78):1-128 |
Recent publications
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Wang A, Koshiaris C, Archer L, et al; STRATIFY investigators. Developing prediction models for electrolyte abnormalities in patients indicated for antihypertensive therapy: evidence-based treatment and monitoring recommendations. J Hypertens. 2025; doi: 10.1097/HJH.0000000000004032 |
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McDonagh STJ, Reburn C, Smith JR, Clark CE. Group-delivered interventions for lowering blood pressure in hypertension: systematic review and meta-analysis. BJGP 2025;75(753):e266-e276 |
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McDonagh S, Cross R, Masoli J, et al. Understanding Measurement of Postural Hypotension (UMPH): a nationwide survey of general practice in England. Br J Gen Pract. 2025;DOI:10.3399/BJGP.2025.0025 |
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Sheppard JP, Temple E, Wang A, et al; OPTiMISE Investigators. Effect of antihypertensive deprescribing on hospitalisation and mortality: long-term follow-up of the OPTiMISE randomised controlled trial. Lancet Healthy Longev. 2024;5(8):e563-e573 |
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Tsang JY, Sperrin M, Blakeman T, Payne RA, Ashcroft D. Defining, identifying and addressing problematic polypharmacy within multimorbidity in primary care: a scoping review. BMJ Open. 2024;14(5):e081698 |
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Parslow RM, Duncan LJ, Caddick B, et al. Collaborative discussions between GPs and pharmacists to optimise patient medication: a qualitative study within a UK primary care clinical trial. Br J Gen Pract. 2024;74(748):e727-e734 |
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Fagbamigbe AF, Agrawal U, Azcoaga-Lorenzo A, et al. Clustering long-term health conditions among 67728 people with multimorbidity using electronic health records in Scotland. PLoS One. 2023;18(11):e0294666 |
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Samarasekera EJ, Clark CE, Kaur S, Patel RS, Mills J. Cardiovascular disease risk assessment and reduction: summary of updated NICE guidance. BMJ 2023;381:1028 |
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Heuvelman H, Davies NM, Ben-Shlomo Y, et al. Antidepressants in pregnancy: applying causal epidemiological methods to understand service-use outcomes in women and long-term neurodevelopmental outcomes in exposed children. Health Technol Assess. 2023;27(15):1-83 |
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Teece L, Sweeting MJ, Hall M, et al. Impact of a Prior Cancer Diagnosis on Quality of Care and Survival Following Acute Myocardial Infarction: Retrospective Population-Based Cohort Study in England. Circ Cardiovasc Qual Outcomes. 2023;16(6):e009236 |
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North TL, Harrison S, Bishop DC, et al. Educational inequality in multimorbidity: causality and causal pathways. A mendelian randomisation study in UK Biobank. BMC Public Health. 2023;23(1):1644 |
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Sheppard JP, Koshiaris C, Stevens R, et al. The association between antihypertensive treatment and serious adverse events by age and frailty: A cohort study. PLoS Med. 2023;20(4):e1004223 |
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Clark C, Warren W, Boddy K, et al. Associations of higher versus lower arm systolic blood pressure with cardiovascular outcomes. A meta-analysis of individual participant data from the INTERPRESS-IPD Collaboration. Hypertension 2022;79:2328-2335 |
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Tammes P, Payne RA, Salisbury C. Association between continuity of primary care and both prescribing and adherence of common cardiovascular medications: a cohort study among patients in England. BMJ Open. 2022;12(9):e063282 |
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Ho ISS, Azcoaga-Lorenzo A, Akbari A, et al. Measuring multimorbidity in research: Delphi consensus study. BMJ Med. 2022;1(1):e000247 |
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Strongman H, Herrett E, Jackson R, et al. Cancer history as a predictor in cardiovascular risk scores: a primary care cohort study. Br J Gen Pract. 2022;73(726):e34-e42 |
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Ling S, Sweeting M, Zaccardi F, Adlam D, Kadam UT. Glycosylated haemoglobin and prognosis in 10,536 people with cancer and pre-existing diabetes: a meta-analysis with dose-response analysis. BMC Cancer. 2022;22(1):1048 |
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Oliver-Williams C, Stevens D, Payne RA, Wilkinson IB, Smith GCS, Wood A. Association between hypertensive disorders of pregnancy and later risk of cardiovascular outcomes. BMC Med. 2022;20(1):19 |
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Scott L, Redaniel MT, Booker M, Payne RA, Tilling K. Regression discontinuity analysis for pharmacovigilance: statin example reflected trial findings showing little evidence of harm. J Clin Epidemiol. 2022;141:121-131 |
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Clark CE, Warren FC, Boddy K, et al. Associations between inter-arm differences in blood pressure, mortality and cardiovascular disease outcomes: individual participant data meta-analysis and development of a prognostic algorithm (INTERPRESS-IPD). Hypertension 2021;77(2):650-661 |
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Gangannagaripalli J, Porter I, Davey A, et al. STOPP/START interventions to improve medicines management for people aged 65 years and over: a realist synthesis. Southampton (UK): NIHR Journals Library; 2021 Nov. PMID: 34846830 |
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Kuberska K, Scheibl F, Sinnott C, et al. GPs' mindlines on deprescribing antihypertensives in older patients with multimorbidity: a qualitative study in English general practice. Br J Gen Pract. 2021;71(708):e498-e507 |
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Hayward S, Hole B, Denholm R, et al; EQUAL Study investigators. International prescribing patterns and polypharmacy in older people with advanced chronic kidney disease: results from the European Quality study. Nephrol Dial Transplant. 2021;36(3):503-511 |
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Hamilton F, Arnold D, Henley W, Payne RA. Aspirin reduces cardiovascular events in patients with pneumonia: a prior event rate ratio analysis in a large primary care database. Eur Respir J. 2021;57(2):2002795 |
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Hamilton F, Arnold D, Payne R. Association of prior lymphopenia with mortality in pneumonia: a cohort study in UK primary care. Br J Gen Pract. 2021;71(703):e148-e156 |
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