Under control: why getting to grips with blood pressure is a win-win intervention for healthcare systems

On World Hypertension Day, Dr Shahed Ahmad, National Clinical Director for Cardiovascular Disease Prevention; Helen Williams, National Specialty Advisor for Cardiovascular Disease Prevention; and Dr Sam Finnikin, National Clinical Specialist Advisor in Personalised Care for Cardiovascular Disease, outline why prioritising hypertension management can save lives and reduce health inequalities.

Poor cardiovascular health can lead to a multitude of serious health issues including heart attacks, strokes, heart failure, and the onset of vascular dementia.

In total, cardiovascular disease (CVD) contributes to a quarter of all deaths in the UK. However, CVD doesn’t affect everyone equally, for example we know that people from South Asian and Black groups are at higher risk, and CVD also accounts for one-fifth of the life expectancy gap between the most and least deprived communities in England.

CVD also has a significant economic burden with around one million hospital admissions in England in 2019/20, leading to 5.5 million bed days. This costs the health system an estimated £7.4 billion and the wider economy around £15.8 billion every year.

And yet, CVD is largely preventable. This is why the NHS Long Term Plan identified it as the single biggest area where the NHS can save lives, through lifestyle changes and earlier detection and treatment.

Hypertension, or high blood pressure, is a key risk factor for CVD and affects 1 in 4 adults, half of whom are undiagnosed or their blood pressure is not controlled. Acting to lower blood pressure can reduce the risk it poses to health. A 10mmHg reduction in blood pressure results in a reduced risk of coronary heart disease (17%), stroke (27%), heart failure (28%) and all-cause mortality (13%) (Ettehad, 2016).

Understandably, hypertension management was significantly impacted during the COVID-19 pandemic. In March 2020, 67.5% of 18 to 79-year-olds with hypertension had a recorded blood pressure within target, but by March 2021 this had fallen to 46.1%.

The latest data shows recovery is underway, but the national ambition is to ensure 80% of patients with hypertension are treated to target by 2029, with a key objective for systems to increase blood pressure control to 77% by March 2024.

Last year, NHS England set out our approach to CVD prevention recovery detailing four high-impact areas that are driving the detection, monitoring and treatment of high-risk conditions. Some examples of how this has been put into practice include:

  • Monitoring and targeting unwarranted variation

    • The CVDPREVENT audit supports primary care teams to understand how many people with CVD are potentially undiagnosed, or under treated. The associated Data and Improvement Tool enables anyone to drill down into the data, showing information at national, ICS, PCN and individual practice level.
  • Prioritising system leadership for CVD prevention

    • Funding has been provided to every ICS to establish a CVD leadership role to facilitate end-to-end pathway improvement. These leaders are supported to undertake their roles through regular engagement and information forums such as the National CVD Prevention FutureNHS workspace.
  • Supporting a system-wide response

    • Blood pressure checks in community pharmacies were rolled out as part of the 2021/22 community pharmacy contract. In 18 months since its launch, around 6,000 pharmacies have delivered over 900,000 checks.
  • Increasing public education

    • To support teams to promote the importance of monitoring and managing blood pressure, we have produced a range of materials including social media content, posters and wallet cards that can be downloaded from the Campaign Resource Centre.

We have also seen many examples of teams adopting their own innovative solutions to improve hypertension control. Examples include Bharani Medical Centre in Slough who reaped the benefits of proactively improving their practice’s control rates, and a project led by two GP practices in Lambeth which had a particular focus to improve control of hypertension among people of black African and black Caribbean descent.

Underpinning all of this is the application of population health management principles to target our resources and taking a personalised care approach that is responsive to our patient’s needs.

Supported self-management can enable patients to monitor their blood pressure at home and, with support from social prescribers or health and wellbeing coaches, make positive lifestyle changes, such as losing weight or stopping smoking.

Many people struggle to engage with health services which can make identifying and managing people with high blood pressure a challenge. Tackling this involves Making Every Contact Count, engaging with local communities and utilising the existing resources such as peer support and voluntary, community and social enterprise organisations. Bridging the gap to healthcare services could help reduce health inequalities and improve health.

Focusing on CVD prevention is one of the most clinical and cost-effective ways of improving the health of our communities. A lot of great work is already being done in this area, and by applying the data we have, working across the whole of health and social care and engaging with the community, we can go further and realise the improvements that are yet to be made.

Dr Shahed Ahmad

Shahed Ahmad, National Clinical Director for Cardiovascular Disease Prevention at NHS England.

Dr Shahed Ahmad is an NHS England Medical Director in the South East Region where he is the Responsible Officer for over 3000 GPs. Shahed was educated at Corpus Christi College, Cambridge and University College and Middlesex School of Medicine. Shahed did his MSc in Public Health at the London School of Hygiene and Tropical Medicine and his leadership training at the London Business School. Before working for NHS England and NHS Improvement, Shahed was a Director of Public Health and led on cardiovascular risk reduction in a number of boroughs. Since joining NHS England, Shahed developed the NHS@2030 programme for GPs in South Central (a number of whom are now clinical directors of primary care networks) and developed the Hampshire Thames Valley Leadership Forum.

National Specialty Adviser for Cardiovascular Disease Prevention at NHS England.

Helen Williams has worked as a CVD specialist pharmacist for the past 25 years in hospital, community and primary care settings. She has spearheaded a wide range of activities across South London and beyond to improve the care of patients with or at risk of cardiovascular disease (CVD). She leads on the development and implementation of consensus evidence-based guidance for use across South London’s 12 CCGs and 7 acute trusts, covering a population of 3.6million and supporting local practitioners through education and training, guideline implementation, clinical audit, service development and provision of virtual or face to face clinics. For the past three years she has provided clinical advice to inform the delivery of local and national AF health innovation network programmes to optimise the detection and management of AF with the aim of reducing AF-related stroke. She developed the pharmacist-led virtual clinic model to optimise uptake of anticoagulation in AF in Lambeth and Southwark CCGs, which is now being spreads nationally through the NHSE AF demonstrator programme. Helen has supported the commissioning and delivery of CVD new models of care to address the CVD ABCs, – AF, blood pressure and cholesterol.

Photo of Dr Sam Finnikin

Dr Finnikin is a GP in Sutton Coldfield, a researcher at the University of Birmingham and a National Clinical Specialist Advisor in personalised care at NHS England. Sam has an interest in shared decision-making and cardiovascular disease and how we can better work with patients to ensure they get the most out of healthcare.