Increasing blood pressure checks in community pharmacy: cardiovascular disease impact
Published 9 May 2023
Applies to England
© Crown copyright 2023
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Background
High blood pressure (hypertension) is a condition that affects the blood vessels. It is the most important risk factor for cardiovascular disease, is responsible for around half of all heart attacks and strokes, and has an estimated annual cost to the NHS of over £2 billion. The Health Survey for England in 2019 reported that 28% of the adult population had hypertension, approximately 12.7 million people at that time.
Increasing blood pressure checks and hypertension detection
Following a successful pilot by NHS England in 2021, a hypertension case finding advanced service (which is an optional service a community pharmacy can choose to provide if they meet specific criteria) was introduced in community pharmacies in England in October 2021 to:
- identify people aged 40 or over, or at the discretion of the pharmacist, people under 40, with high blood pressure and refer them to their GP to confirm diagnosis and for appropriate management
- at the request of a GP, undertake ad hoc clinic and ambulatory blood pressure measurements (ABPM)
- promote healthy behaviours to patients
The following analysis estimates the potential benefits of a policy to increase numbers of blood pressure checks in community pharmacies based on the assumption that an additional 2.5 million people would undergo a blood pressure check, a figure which is in line with the ambitions of the current policy proposal.
Results
Scenario 1: increasing hypertension detection to 70% in the first year (optimistic scenario)
Table 1 shows the potential number of cardiovascular disease (CVD) events avoided by increasing hypertension detection to 70%. CVD includes heart attacks, strokes, angina and heart failure. This is a very optimistic scenario where detection increases from 63% to 70% in the first year (see methodology).
Table 1: CVD events avoided with 70% hypertension detection in England (from baseline of 63%)
| Outcome | Year 1 | Year 5 | Year 10 | Year 20 |
|---|---|---|---|---|
| CVD events avoided | 1,356 | 9,183 | 18,175 | 33,870 |
| Heart attacks avoided | 283 | 2,218 | 4,480 | 8,830 |
| Strokes avoided | 425 | 2,027 | 5,165 | 10,522 |
| Primary care costs saved from CVD avoided (£000s) | £1,059 | £15,275 | £44,373 | £111,086 |
| Secondary care costs saved from CVD avoided (£000s) | £8,707 | £67,089 | £173,484 | £388,646 |
| Social care costs saved from CVD avoided (£000s) | £3,436 | £38,591 | £122,439 | £305,377 |
| Premature mortality cases reduced (less than 75 years) | 148 | 602 | 1,640 | 3,344 |
| Life years gained | 0 | 2,130 | 12,274 | 53,155 |
| Quality-adjusted life years gained | 135 | 4,797 | 20,389 | 70,370 |
Scenario 2: increasing hypertension detection to 68% after year 3 (more likely scenario)
Table 2 shows the CVD events avoided by increasing detection progressively from 63% to 68% after year 3. This is a more likely scenario that assumes that detection of hypertension would increase incrementally from baseline levels to year 3 at 68% (see methodology).
Table 2: CVD events avoided with 68% hypertension detection from year 3 in England (from baseline of 63%)
| Outcome | Year 1 | Year 5 | Year 10 | Year 20 |
|---|---|---|---|---|
| CVD events avoided | 90 | 4,831 | 12,323 | 23,788 |
| Heart attacks avoided | 33 | 1,193 | 3,101 | 6,178 |
| Strokes avoided | 9 | 819 | 3,110 | 8,106 |
| Primary care costs saved from CVD avoided (£000s) | £67 | £6,171 | £25,506 | £72,663 |
| Secondary care costs saved from CVD avoided (£000s) | £496 | £28,851 | £100,752 | £258,035 |
| Social care costs saved from CVD avoided (£000s) | £69 | £10,972 | £58,068 | £183,824 |
| Premature mortality cases reduced (less than 75 years) | 13 | 134 | 1,162 | 2,727 |
| Life years gained | 0 | 477 | 5,914 | 35,980 |
| Quality-adjusted life years gained | 6 | 1,411 | 10,321 | 46,025 |
Methodology
About the data
The results in tables 1 and 2 are calculated using the CVD prevention return on investment tool. This tool provides health benefits and costs from avoidance of CVD events compared to the cost of certain interventions, such as increasing the detection of hypertension in the community. This is referred to as return on investment (ROI). The CVD ROI tool is a population simulation model that finds and treats patients over 20 years and allows the user to specify a change in either or both the diagnosis levels or management levels of these patients (from current levels) to find the additional CVD burden and cost of any improvement.
Estimating CVD events avoided from increased blood pressure checks
We have assumed that 2 million of the 2.5 million people attending blood pressure checks would be opportunistic visits and not referred from a GP or other healthcare setting. It is assumed that none of the 2 million people would otherwise have been diagnosed with hypertension in other healthcare or non-healthcare settings.
We have assumed 2 plausible scenarios due to a policy of increasing blood pressure checks in community pharmacies. The first scenario (Table 1) assumes that hypertension detection in pharmacies could be as high as 10% in the first 5 years. We have assumed this scenario increases diagnosed hypertension in the population from the current baseline value in the CVD ROI tool of 63% to 70%.
The second scenario (Table 2) is considered a more likely scenario where hypertension detection in pharmacies could be as high as 6% after the first 5 years, but in the first 2 years it would only be 3%. We have assumed that in this scenario the proportion of diagnosed hypertension increases in the population incrementally from 63% to 64% in year 1 and 2 and to 68% from year 3 onwards.
Both scenarios assume that management of people diagnosed with hypertension will be the same for existing and newly detected patients .
The cost outputs from the ROI tool have been uplifted from the 2016 to 2017 costs in the CVD ROI tool to 2021 to 2022 costs using the March 2023 budget GDP deflator.
Caveats
These results are based on assumptions of detection of hypertension and a published ROI tool. The ROI tool was not based on empirical data from pharmacy blood pressure checks, so both scenarios are approximations based on hypothetical increases in detection rates of either 68% or 70% respectively from baseline levels. The tool does not allow the user to change the detection percentage in the population at every year, only the first 3 years, so estimating the effect of a changing percentage detection each year is not possible.
Contact information
For enquiries relating to the statistics or to offer feedback on the publication, contact Andrew Hughes: ncvin-ohid@dhsc.gov.uk.