Guidance

High blood pressure: plan and deliver effective services and treatment

Preventing people in England from developing high blood pressure (hypertension), and detecting and managing it better in those who have it.

High blood pressure, or hypertension, affects more than 1 in 4 adults, and is the second biggest risk factor for premature death and disability in England.

A group of organisations have come together with Public Health England (PHE) to develop an action plan for improving the prevention, detection and management of high blood pressure in England.

PHE wants to support local leadership in dealing with high blood pressure, and has gathered resources to help those planning and implementing high blood pressure services and initiatives, including case studies and examples of emerging practice.

If you are a member of the public and want to find out more about blood pressure, see NHS Choices.

For information about the risk factors associated with high blood pressure, see the Smoke Free Resource Centre, the Live Well: food and diet site, the Alcohol Learning Centre and Let’s Get Moving.

Planning blood pressure services and initiatives

These resources can help assess local need, plan services and undertake effective commissioning of healthcare services to detect and manage high blood pressure.

Data sources

A series of Hypertension profiles are available for each clinical commissioning group (CCG) and lower tier local authority. The hypertension profiles show each local authority how well they are doing in detecting and treating high blood pressure by comparing its performance with that of similar authorities and with the rest of England.

The CVD prevention opportunities tool provides a snapshot view of potential savings and costs in disease outcomes if primary care treatment of cardiovascular and related conditions were optimised.

The Healthier lives: high blood pressure interactive variation atlas presents performance data on blood pressure risk factors, prevalence, detection and care. This data is available at local authority, CCG and general practice level, bringing together existing public data.

Find more detailed comparison tools, at GP level, on National general practice profiles.

The National cardiovascular disease profiles allow you to download a cardiovascular disease (CVD) health profile for each clinical commissioning group and strategic clinical network in England.

The CVD commissioning for value focus packs for clinical commissioning groups use national benchmarked data for heart disease and stroke. This data helps commissioners understand variation across the pathway for each CCG, to help improve commissioning.

PHE’s data and analysis tools ‘Health inequalities’ provides comprehensive data tools on health inequalities across England.

Guidance

PHE’s Making Every Contact Count (MECC): practical resources will support the local implementation and evaluation of MECC activity and the development of training resources.

PHE’s Healthier and more sustainable catering guidance offers practical advice on how to make catering affordable, healthier and more sustainable, including advice relating to salt.

The Faculty of Public Health’s Toolkit for developing a local strategy to deal with high blood pressure is a comprehensive resource, giving local partners useful information, tools, templates and checklists to help develop effective strategies on high blood pressure prevention, detection and control. Developed in 2005, some bodies and structures described have since been superseded.

NICE’s Guide to the commissioning of services for the prevention of cardiovascular disease provides advice on the invest-to-save potential of commissioning a range of interventions to prevent modifiable risk factors associated with cardiovascular disease, and designing services accordingly.

England still lags behind the best in the world in dealing with high blood pressure. The Canadian effort to prevent and control hypertension is an inspirational article about lessons from Canada’s approach which increased high blood pressure treatment and control rates fivefold over a decade. This article requires an academic login or purchase.

The NHS Health Check in England: an evaluation of the first 4 years research paper, published on 14 January 2016, is the first major national evaluation of the NHS Health Check programme in England.

NHS Health Check information for commissioners and providers provides a useful overview of the NHS Health Check programme, links to relevant case studies, and data for each local authority.

The Health Inequalities National Support Team provides tools for commissioners on reducing health inequalities, particularly ‘Closing the gap: finding the missing thousands’ and the ‘How to guide on tools, methodologies and datasets to help address health inequalities’.

Making the case

The following resources have been provided to help make the case for action on blood pressure within your organisation:

The slides set out:

  • why blood pressure matters
  • what PHE and partners are doing
  • what different organisations can do
  • what tools and resources are available to help

These can be adapted for different organisations and audiences.

Delivering blood pressure work in practice

These resources can help health professionals provide effective treatment and care, as well as increase public understanding of high blood pressure.

Guidance

NICE’s Hypertension: clinical management of primary hypertension in adults offers authoritative, evidence-based advice on the care and treatment of adults with primary hypertension.

The NICE hypertension clinical guideline tools and resources help put NICE guidance into practice with baseline assessment tools, clinical audit tools and costing templates.

NICE has a Hypertension quality standard which defines clinical best practice in the management of primary hypertension.

The Hypertension pathway is an interactive tool providing fast access to NICE guidance and associated products.

For patient conversations

The JBS3 CVD risk calculator and the Q-Risk calculator are tools which help health professionals to communicate a patients’ risk of cardiovascular disease, and also show the benefits that interventions can have on reducing their risk.

Blood Pressure UK resources for health professionals and British Heart Foundation resources for health professionals provide sets of resources to help inform patients about high blood pressure prevention, diagnosis and management.

NHS Right Care’s high blood pressure decision aid helps health professionals and patients make a shared decision on blood pressure treatment.

Canada and the USA have both set up and run effective high blood pressure campaigns in the past few years which have provided useful resources for health professionals, including:

Be aware of slight differences in clinical guidelines abroad.

Other tools

An Implementation guide and toolkit for making every contact count provides advice on how to use every contact to encourage healthier lifestyle choices.

The British Heart Foundation created a Business case toolkit for health professionals to help them make a case for the creation of a new service, or to secure or develop an existing service.

The Lester Tool is a downloadable resource designed to help health professionals offer safe, effective care that improves the physical health of people with severe mental illness.

Cardiovascular risk training for pharmacists helps them understand best practice in managing cardiovascular risk and specific training, using New medicine service – anti-hypertensives is also available.

The British Hypertension Society maintains a list of Blood pressure monitors validated for home use and Blood pressure monitors validated for clinical use, as well as How to measure blood pressure guides.

The Royal Pharmaceutical Society has produced a Pharmacy quick reference guide to blood pressure monitoring, available to RPS members only.

The Patient Activation Measure is a tool to assess the knowledge, skills and confidence required for a patient to manage their own health and healthcare.

The Centre for Disease Control in the USA has developed a Global standardised hypertension treatment project toolkit which gives healthcare providers the tools they need to improve blood pressure control among their clinic population, including information on how to create registries to manage panels of patients and track indicators, as well as how to use standardised hypertension treatment protocols to improve the treatment and control of hypertension in clinical settings.

The World Hypertension League has created a Train the trainer programme to give experts the resources to run the training sessions for the development of blood pressure screening programmes. Areas will want to tailor this to local circumstances but the video called ‘Screening for hypertension: how to best measure blood pressure’ is particularly useful.

Case studies

Using practice based pharmacists to manage hypertension in Dudley sets out the local approach developed to optimise hypertension management,amongst the local population.

The Blackpool Hypertension Project used GP registers and community events to identify and treat those with existing but undiagnosed hypertension, resulting in over 2,500 patients being added to hypertension registers and a 5% increase in the prescribing of anti-hypertensive drugs.

The Stoke-on-Trent Advice and Interactive text Messaging (AIM) for Health used the simple telehealth ‘Flo’ system to support patients to take responsibility for monitoring and shared management of their condition, treatment or lifestyle.

Stockport’s ‘Know your numbers’ blood pressure campaign increased the number of blood pressure checks via community engagement (including the use of health kiosks) and a public campaign.

Tower Hamlets’ managed practice networks led to significant improvements in the treatment of cardiovascular disease. As a result, Tower Hamlets was the highest ranked CCG in England in the 2013 to 2014 Quality and Outcomes Framework for blood pressure control in people with coronary heart disease and diabetes.

The NHS Health Check case study hub provides case studies across a range of themes including outreach and increasing access, IT and prisons.

More case studies are on their way. If you have one you would like to contribute or have ideas for other resources we could include, please email bloodpressure@phe.gov.uk.

Published 18 November 2014
Last updated 30 March 2015 + show all updates
  1. Added 'Global Standardised Hypertension Treatment Project Toolkit' and 'Train the Trainer Programme' information.
  2. First published.