I worked in cardiovascular prevention nursing at Bart’s Health Tower Hamlets Community Health Services, running clinics in general practices with an aim of optimising cardiovascular disease risk factors including blood pressure. As such, I am aware of the challenges and the multiplicity of contributing factors to blood pressure care and management for example, lack of awareness of risk of diseases, polypharmacy, and patient adherence among others.
Arguably, there is a need to improve management of this risk factor and “Tackling high blood pressure: from evidence into action” was launched approximately six months ago by Public Health England. This is a collaboration of members that make up the Blood Pressure System Leadership Board (BPSLB), with a mandate to improve prevention, detection and management of high blood pressure. Inspired by the Canadian effort to prevent and control hypertension, the board recognises that with a strategic approach and engagements at different levels of the system; we can meet our aspiration of better blood pressure control through enhanced prevention, detection and management.
NHS Improving Quality (NHS IQ) is a member of the BPSLB and we are working with partners including Public Health England to improve health outcomes across England by providing improvement and change expertise. This programme is within the Living longer Lives (LLL) Improvement Programme , the overall aim of which is to reduce the number of people who die too soon from illness or disease that could have been prevented or treated. Structured around the CVD-OS strategy it echoes the current thinking on prevention in the NHS. The Five Year Forward View stresses the need for prevention and the evidence confirms that by reducing BP we can prevent cardiovascular diseases. High blood pressure is the second biggest risk factor of disease leading to premature mortality in this country and is recognised as a major risk factor for stroke, heart attack, heart failure, chronic kidney disease and cognitive decline.
Therefore, the need for behaviour change strategies within this preventative model of care cannot be over emphasised. Engaging patients and clinicians in the process to optimise blood pressure is crucial. From a professional perspective it is imperative that we use the NICE guidelines for the management and diagnosis of blood pressure. Additionally, the NHS health check is a way of detecting BP, appreciating that this covers the age group 40 to 74 years old and there are also opportunities to use pharmacists and other models of care.
Some examples of programmes which have led to BP improvement include the model adapted in Tower Hamlets which is one of the most deprived boroughs in the UK they used managed practice networks to improve cardiovascular diseases management, the Kaiser Permanente approach used in Northern California and the Canadian approach. Evidently, there is not a one size fits all method to BP system management, but we must focus on tackling this risk factor with a consistent plan to reduce blood pressure, alongside other cardiovascular disease risk factors.
The current focus is on prevention, with national initiatives to reduce the impending burden of diseases on the health services. This gives us possibilities to collaborate on prevention measures across the cardiovascular disease spectrum. As left untreated high blood pressure will cause strokes, heart failure and chronic kidney diseases. Inevitably this puts a strain on the NHS, the patients who will need long term care and the wider networks, with far reaching consequences.
Therefore at NHSIQ we are keen to work with pilot sites to use improvement methodologies to reduce blood pressure, and would like to hear about good work which we could use as case studies. In addition, we will use the voices of our expert patients and social media to engage change and improvement across the system.
If you are involved in work to improve blood pressure or would like to do so please get in touch.
Sylvia Richards, Programme Delivery Manager, Living Longer Lives,
NHS Improving Quality