Transforming the management of high blood pressure

People with high blood pressure are receiving better care thanks to an improvement programme delivered by the Innovation Agency and fellow AHSNs across England.

Around 200 GPs in Cheshire, Merseyside, Lancashire and South Cumbria are using a Blood Pressure Quality Improvement Toolkit, reducing the risk of cardiovascular disease.

The toolkit is a collaboratively and locally developed package that embeds into primary care software systems EMIS and System One, helping GPs and their teams to deliver best practice through dashboards and consultation templates.

Health Innovation North West Coast has a dedicated team supporting clinicians in the North West Coast to improve management of high blood pressure by using the toolkit.

Wirral GP Dr David Baker said: “I run the BPQI toolkit every month now; I use it to create my lists of patients, then batch-message out those targeted groups of patients using a system through which they respond with their blood pressure readings.”

All 15 Academic Health Science Networks (AHSNs) including the Innovation Agency have been supporting the adoption of search and stratification toolkits, based on the UCLPartners Proactive Care Frameworks which tackle the biggest risk factors of cardiovascular disease

With national coordination provided by UCLPartners, over 600 primary care networks in England (nearly half) are now using the frameworks.

The frameworks prioritise clinical activity by stratifying patients who are at highest risk, using the wider workforce to reduce the workload for GPs, while personalising care for patients.

Evidence shows that optimising treatment for blood pressure and cholesterol can prevent cardiovascular events: one heart attack is prevented over five years for every 100 patients with high blood pressure and one stroke for every 67 patients. And for every 100 patients with pre-existing CVD who are treated with a statin, 10 heart attacks or strokes will be prevented.

The impact of this work is summarised in a new Blood Pressure Optimisation Programme report.

Dr Matt Kearney, GP and Executive Clinical Director, Cardiovascular Health at UCLPartners said: "Improving the management of high-risk conditions like blood pressure is a ‘wicked issue’ that has progressed little over several decades. This work demonstrates how, together, we’re laying strong foundations, but this only the start. If we continue the spread and adoption of this work and supporting primary care to optimise blood pressure at scale, we will prevent huge numbers of heart attacks and strokes now and in years to come.”

Case-finding and optimal management for high blood pressure is one of the five clinical areas identified as requiring accelerated improvement in NHS England’s Core20PLUS5. Incidence of high blood pressure within the most deprived communities is roughly double that of the most affluent areas. The BPO programme has helped to tackle such stark health inequalities through a structured and systematic approach.

Dr Bola Owolabi, Director Health Inequalities at NHS England said: “I am delighted to see the work of the AHSNs in supporting colleagues to systematically address hypertension and the explicit focus this programme has on tackling health inequalities. If Integrated Care Boards continue to prioritise support for blood pressure optimisation in communities at greatest risk, this will prevent heart attacks and strokes in these communities and reduce health inequalities due to cardiovascular disease.”