Hypertension (HT)

Published on 1 December 2021

About the project

Cardiovascular disease (CVD) is a leading cause of premature morbidity and mortality in England. The global burden of disease study identified high blood pressure and high cholesterol as leading modifiable risk factors that drive mortality and morbidity from CVD.

Treatment of high blood pressure and high cholesterol substantially lowers the risk of CVD. Despite this, both HT and hypercholesterolaemia are underdiagnosed and undertreated. Around 30% of people with HT are unaware of their condition. Pre-pandemic Quality and Outcomes Framework (QOF) data showed that around one third of people with diagnosed HT are not treated to QOF target and that there is substantial variation across the region.

Around 50% of people with established CVD also have HT. All men over the age of 55 with HT and women over the age of 60 with HT who do not have CVD are nevertheless at high risk (with a QRISK score above 10%). These individuals should be offered treatment with lipid lowering therapy, but large numbers are either on no treatment or suboptimal treatment.

HIWM CVD Prevention and Management team will support Primary Care Networks (PCNs) to implement the UCL Partners Proactive Care Framework for HT, enabling optimised clinical care and self-management of people with HT. This will be achieved through:

Risk stratification to prioritise which patients to see first
Use of the wider workforce to support remote care and self-care
Supporting systems to adapt the framework pathways for local implementation
Supporting patients to maximise the benefits of remote monitoring and virtual consultations where appropriate

We will also support PCNs to increase detection of people with HT through case finding interventions (including practice case finding through patient record searches, and models that involve the new HT community pharmacy scheme). We will support systems to reduce health inequalities by targeting those populations that fall in the 20% most deprived PCNs and other local priority groups (applying the Core20PLUS5 framework).

The Blood Pressure Optimisation programme supports systems to take a multi-morbidity approach in supporting patients with HT. This approach will enable the Health Innovation Networks to deliver on the objectives of both the NHS England @home programme and the Health Innovation Network National Lipids and Familial Hypercholesterolaemia programme.