Managing blood pressure can save lives and reduce the risk of a heart attack or stroke

Earlier this month we took part in Know Your Numbers! Week . The campaign encourages people to get their blood pressure checked to help keep them safe. High blood pressure, or hypertension, can cause cardiovascular disease increasing the chances of heart attack, stroke and dementia. As part of the Academic Health Science Network (AHSN) UCLPartners is supporting primary care teams to help manage blood pressure and save lives.

Just over a quarter of adults in the UK have high blood pressure, but around one in three are unaware as it doesn’t usually cause any symptoms. So the only way to find out is to have a blood pressure check.?

Patients checking their blood pressure themselves, or having it measured by a healthcare professional can ensure they get the treatment they need if the reading is high. A reading consists of two numbers, the first is when the pressure is at its highest (systolic pressure), the second is when the pressure is at its lowest (diastolic pressure). High blood pressure exists when the systolic is consistently above 140 mmHg and the diastolic above 90 mmHg. The NHS website has more information on managing high blood pressure.

Even when hypertension is diagnosed, many people are not treated to target. The Size of the Prize resource published by UCLPartners shows the potential for real ambition in preventing cardiovascular disease at scale by optimising the management of high blood pressure. In England in 3 years there is potential to prevent 4,866 heart attacks and 7,263 strokes, not only a huge cost saving to the NHS but a real opportunity to improve care for those patients.

Optimising care for patients with hypertension

The AHSN National Blood Pressure Optimisation programme was launched at the beginning of this year with the aim of transforming cardiovascular disease prevention by optimising the clinical care and self-management of people with hypertension. The programme is centred on implementation of the UCLPartners Proactive Care Framework for hypertension which includes risk stratification to prioritise patients for treatment optimisation, and deployment of the wider workforce to provide systematic support for education, self-management and behaviour change. ?This approach enables those with most poorly controlled hypertension to be seen earlier by the appropriate clinician but also safely manage the care of all patients by working with the wider primary care team in a more integrated way.

The Frameworks were developed in 2020 to help primary care restore and transform management of long-term conditions as we emerge from the pandemic. Early evaluation findings show staff reported improved patient care and better support for self-management and personalisation of care. They have been widely welcomed in primary care. A common GP response is that they offer a real-world solution, helping them to do things differently to improve care and release clinician capacity as they deal with the post-pandemic backlog.

Reduction of disease burden of patients with hypertension in north and east London

In Haringey , North Central London, the UCLPartners Hypertension Framework was implemented in 5 practices. Over 3 months, they demonstrated a 41% reduction in patients in the highest risk group and 13% reduction in the second highest risk group.

In Stratford , North East London, the Hypertension Framework was implemented in 5 practices and by targeting treatment optimisation they significantly reduced the percentage of patients in the highest risk group from 16% to 3%.

Working as a network to improve care outcomes for people with high blood pressure

All 15 AHSNs are supporting implementation of the Blood Pressure Optimisation Programme and working with their Primary Care Networks (PCNs) and local systems. UCLPartners is coordinating the programme and providing implementation support to enable adoption. To date 174 PCNs have been involved in implementation, this includes 485 practices. The work is continuing with the aim to have 623 PCNs with at least one practice at implementation stage by the end of year one.

AHSNs will also support PCNs in identifying more patients with hypertension through case finding interventions and support Integrated Care Systems in reducing health inequalities by targeting the most deprived populations and other local priority groups. Each delivery team has worked with their local healthcare systems and guidance from the NHSE Core20PLUS5 to support a reduction in health inequalities. Using Quality and Outcomes Framework (QOF) data for hypertension treatment and Indices of Multiple Deprivation (IMD) they have identified the 20% of practices who may benefit from additional support to reduce health inequalities.

Kate Phillips, National CVD Programme Manager, UCLPartners said: “It's exciting to see the different approaches that each AHSN team is taking to deliver this programme, they are ensuring that the resources and opportunities add real value to their local healthcare systems. It's great to see the programme evolving and gaining momentum, hypertension management is already improving in implementation areas."

If you want more information on the programme and how your local AHSN can support you in implementing the hypertension Framework please contact [email protected]