Why is it a priority?

High Blood Pressure (BP) is the second most preventable risk factor for premature death and disability in particular cardiovascular and circulatory disease. Each 2 mmHg rise in systolic BP is associated with a 7% increased risk of mortality from ischaemic heart disease and a 10% increased risk of mortality from stroke.

In Greenwich it is estimated that 23% (59,500) of the population is living with hypertension (PHE, 2016). However, of those only 58% (34,600) are diagnosed with hypertension and 46% (27,300) controlled. This is comparable to London and England but below international standards like Canada with 83% diagnosed and 66% controlled.

There is significant variation between GP practices both between observed/expected prevalence and in the control of BP rates. Unwarranted variation remains a particular challenge. Health inequalities exist with those living in more deprived areas and some Black and ethnic minority populations having a higher risk of having high BP.

HBP (1)     HBP (2)

 

What could make a difference at a local level?

Improvements in prevention, detection and management of hypertension with a focus on reducing health inequalities including:

  • Increasing uptake of lifestyle behaviour change support that focuses on the main modifiable risk factors including excess weight, lack of physical activity, excess alcohol intake, excess dietary salt and psychosocial stressors
  • Ensuring a strong focus on early detection schemes including focus on those that are at higher risk of having a high BP
  • Strengthening the systematic management of high BP including reducing variation in practice

What are the opportunities for improvement in Greenwich?

Prevention:

  • Support behavioural change training for health and social care professionals and others to enable effective conversations about healthy lifestyle and effective signposting to available support e.g. community directory, social prescribing
  • Increase personal behaviour change prompted through individuals’ regular contacts with health and social care and others (Make Every Contact Count)
  • Integrate prevention and lifestyle modification as part of all clinical care pathways and strengthen pathways to maximise appropriate referrals into appropriate behaviour change support e.g. NHS Health Check
  • Create an environment which promotes physical activity and reduce likelihood of obesity (e.g. through local planning, licensing, and other leverages etc.)

Detection

  • Develop approaches to improve opportunistic testing, systematic case finding of those at high risk and identify means to improve uptake of NHS Health Checks including targeted approaches

Management

  • Local leadership and action planning for system change, to tackle particular areas of local variation, and achieve models of person-centric care e.g. Year of Care, Local Care Networks
  • Consistent implementation of NICE guidance in relation control of hypertension

Please refer to the full chapter on Hypertension (High Blood Pressure) for more information.