Size of the Prize for High Blood Pressure – Preventing Heart Attacks and Strokes at Scale

High blood pressure is one of the leading causes of heart attack and stroke, common conditions that account for a quarter of premature deaths and 25% of the life expectancy gap between most affluent and most deprived communities. Treatment to lower blood pressure is highly effective at preventing these life-changing events, reducing demand on hospital services, and reducing health and social care costs.

Despite this, many people with hypertension are not on optimal treatment. Before the pandemic, Quality and Outcomes Framework (QOF) data showed that around a third of people with diagnosed hypertension were not treated to target, with substantial variation across the country. Most recent QOF data (2020-21) shows that optimisation rates have deteriorated substantially during the pandemic as patients’ access to healthcare has been disrupted.

For each ICS and region in England, Size of the Prize shows on a single slide:

• The impact of COVID: in disrupting treatment for people with hypertension. On average the proportion with optimally controlled blood pressure has fallen from 70% to under 50%.
• The risk: how many strokes and heart attacks might result if that disruption is not rapidly corrected. Across England this number exceeds 27,000 in three years.
• The ambition: how many additional heart attacks and strokes can be prevented in three years and what savings can be generated if more people have their treatment optimised – with three levels of ambition.

How can we deliver on this ambition? UCLPartners has also developed a suite of resources to help primary care transform the management of hypertension and other conditions as we emerge from the pandemic. These resources are already being used by Integrated Care Systems and Primary Care Networks across the country as part of NHS England’s Proactive Care @home programme and are at the heart of the national Blood Pressure Optimisation programme. By supporting primary care to do things differently, these practical resources will help GPs and their teams to tackle the post-COVID backlog and to drive improvements in population health.

There are two core elements to the UCLPartners Proactive Care Frameworks:

1. Risk stratification and prioritisation: search tools built for EMIS and SystmOne that risk stratify patients with hypertension so that clinicians can prioritise their work – ensuring that everyone is offered appropriate care but that those at greatest risk are seen earliest.
2. Systematic support for patient education and self-management: extensive resources for staff, such as healthcare assistants, to help patients understand their conditions and to care for themselves – improving quality of care and freeing up clinician capacity.

Using these and other quality improvement tools, the 15 AHSNs across England will be working with local clinical and system leaders: supporting primary care to case-find patients with hypertension who have suboptimal blood pressure (and cholesterol – because this too is major cause of heart attack and stroke), and to optimise their treatment.

Size of the Prize shows us that the potential population health gain is huge: across the whole of England, improving blood pressure optimisation so that 80% of people are treated to target would prevent around 12,000 heart attacks and strokes and save over £135 million in health care costs alone over three years.

As the NHS recovers from Covid, we have the opportunity to transform the way we deliver care. So, let’s be ambitious in our plans for blood pressure optimisation!