Proactive hypertension care: The quiet demand we can’t forget

All Suvera content is reviewed by clinicians
Primary Care
Healthcare
Technology

Proactive hypertension care: The quiet demand we can’t forget

Suvera examines the possibilities of upstream prevention and why they are too great to ignore

Today, hypertension remains the number one risk factor for death globally, affecting more the one billion people.1 In the UK, around 30% of adults are living with high blood pressure and 4.2 million may be undiagnosed.2

If you’re working in the system, you’ll be all too aware of the increasing focus within the NHS on tackling ‘the silent killer’ in a more effective and efficient way. Whether it’s delivering proactive, earlier interventions to hypertensive populations who are uncontrolled, or finding the ‘missing millions’ not currently diagnosed.

With this comes challenging goals. Systems have a key objective to increase blood pressure control to 77%. And by 2029, the vision is for 80% of patients with hypertension to be treated to target.3

Some lofty ambitions for sure, but are they possible? In a word, yes. Here at Suvera, we've seen first hand what can be accomplished working with our primary care partners. Here, we take a closer look at possibilities, current problems and offer some proof on what can be achieved.

Sizing up the benefits of optimal control

Combating high blood pressure has significant benefits for population health and the system at large. Purely speaking in health terms, we know a 10mmHg reduction can reduce risk of major cardiovascular disease events (20%), coronary heart disease (17%), stroke (27%), heart failure (28%) and all-cause mortality (13%).3,4

While projections from UCLPartners’ Size of the Prize resource point to similar impacts at a system level.

Using integrated care board data to illustrate potential gains of blood pressure control, it shows current optimisation rates at around 67% treated to target. With an increase to 80%, approximately 16,000 heart attacks and strokes could be prevented over three years, equating to £180 million in savings.5

And this doesn't even begin to quantify gains in clinical capacity that could be delivered as a by-product of such results. Make no mistake, reductions in blood pressure often go together with a reduction in pressure on health services.

The persistent problem of demand

But these are big numbers and achieving them isn’t easy.

“There are not many interventions that would deliver this level of population health impact with the accompanying reduction in demand for expensive health and social care.”

- Is QOF bad for your heart?6

Certainly, ever-present and immediate demand challenges pose a continuing obstacle to proactive management. One need only look at how optimisation rates can fall off at the end of QOF year as teams inevitably return to grappling with the day-to-day.5

What does this tell us? The will is there, but the way may be missing or currently blocked. The cycle caused by the supply-demand mismatch may be leaving care providers’ hands tied in a proverbial catch 22 situation. But proactive hypertension care is a quiet demand we can’t afford to forget.

What’s the answer?

It invariably comes down to taking a digitally-enabled population health approach. Hypertension requires ongoing management. So, we need to combine year-round case finding and proactive intervention to manage blood pressure as well as other long-term conditions.

That starts with interrogating available data, risk stratifying populations, and implementing a structured system to optimise care, treatment and lifestyle habits.

A care team combining specialist expertise of clinical pharmacy alongside GPs can prioritise patients effectively and deliver such a model. And appropriate sequences of care can be established and automated with the right tech and tools. This can enable teams to systematically plan interventions and track progress across populations, while overcoming capacity issues.

The importance of communication

The success of such models also relies on fostering good patient engagement and optimal communication. We know this is a persistent issue around hypertension. After all, it isn’t known as the silent killer for no reason. There are often no ‘visible clues’, and the first ‘symptom’ may unfortunately be a heart attack or a stroke. Thus, breaking the silence is essential.

We need only look at the data.  A survey commissioned by NHS England of adults over 40 found:7

  • 41% didn’t know untreated high blood pressure could lead to heart disease
  • 22% were not aware hypertension causes heart attacks or strokes  
  • 44% were unaware of free blood pressure checks at pharmacies
  • 59% didn’t know they would not need an appointment to get checked

Thankfully, there are efforts underway to increase awareness of available services and why individuals should take action such as the ‘hypertension leaves no clues’ national campaign. But what other ways can we keep blood pressure front of mind in the daily lives of people?

One way is by providing more convenient means to help patients ‘know their numbers.’ When individuals actively record and track health data in digital platforms, it can foster greater ownership of health. Such tools can also provide a source of ongoing education and lifestyle advice, support remote monitoring and enable the patient to have a consultation with a clinician where required.

What happens when it all works

When all these elements come together, it adds up to better population health.

For example, here at Suvera, we’re delivering a 12.65 mmHg average change in systolic blood pressure across our services. And with our virtual clinic model, we have helped system partners like Enfield South West PCN end the financial year with an average 83% target achievement in key QOF indicators across all practices.

Now, we’re supporting integrated care systems like South West London ICS to pioneer transformative hypertension programmes to improve control, address health inequalities and enhance patient outcomes.

While the ambitions are big, we know that achieving them is possible. And the rewards for patients and the health system are too great not to succeed.

Need support?

Suvera provides a population health platform, virtual clinic and chronic care capacity to help NHS partners improve chronic condition management at scale.

Support is available for ICSs, ICBs, PCNs and practices. If you’d like to discuss what’s possible for your population, contact our team on partnerships@suvera.co.uk.

Read our case studies here.

References

  1. World Heart Federation. Hypertension. Available online: https://world-heart-federation.org/what-we-do/hypertension
  2. British Heart Foundation. Available online: bhf.org.uk/what-we-do/news-from-the-bhf/news-archive/2024/march/bhf-backs-nhs-blood-pressure-testing-campaign
  3. NHS England. Under control: why getting to grips with blood pressure is a win-win intervention for healthcare systems. Available online: england.nhs.uk/blog/under-control-why-getting-to-grips-with-blood-pressure-is-a-win-win-intervention-for-healthcare-systems/
  4. Ettehad D, et al. Lancet 2016; 387: 957–67.
  5. UCL Partners. Available online: https://uclpartners.com/project/size-of-the-prize-for-preventing-heart-attacks-and-strokes-at-scale
  6. NHS Confederation. Is QOF bad for your heart? Available online:   https://www.nhsconfed.org/articles/qof-bad-your-heart
  7. The Pharmacist. ‘Too many’ unaware of pharmacy blood pressure checks. Available online: thepharmacist.co.uk/clinical/cardiovascular/too-many-unaware-of-pharmacy-blood-pressure-checks/