Hypertension: The NHS Blood Pressure Checks Service

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The NHS commissioned a new advanced service, the Hypertension case-finding service on 1st October 2021. This followed a pilot programme by NHS England and NHS Improvement (NHSE&I) in 2020 where community pharmacies offered blood pressure checks to people 40 years and older.

The plan was to pilot case findings for undiagnosed cardiovascular disease since it is one of the leading causes of premature death in England. To support the detection of high blood pressure, the commissioned service is now live in community pharmacies across England.

What is Hypertension?

Blood pressure, or hypertension, seldom has visible symptoms. However, if inadequately treated, it raises the danger of serious issues such as heart attacks and strokes. The fact is, there are 5.5 million adults in England with undiagnosed hypertension, which is a cause for concern.

The State Of Cardiovascular Disease (CVD) In The UK

As one of the primary causes of premature death, Cardiovascular disease (CVD) affects seven million people and accounts for 1.6 million disability-adjusted life years. This places a huge and unnecessary financial burden on the NHS reaching close to £9 billion per year. By better managing hypertension and reducing the number of CVD cases, some of this money can be used elsewhere.

According to research, Cardiovascular disease drives health inequality and these statistics certainly tell a story.

  • It accounts for approximately 25% of the average life expectancy gap between the affluent and poorer populations in England. Currently, it is 27% in men and 24% in women.
  • The most deprived 10% of the population are almost twice as likely to die as a result of CVD compared to the least deprived 10%.
  • For those living with severe mental illness, 60% of excess mortality can be attributed to preventable physical conditions such as heart disease

Causes Of High Blood Pressure (Hypertension)

Unlike other conditions, the causes of high blood pressure are not always clear. However, a few factors could contribute to an increased risk of hypertension, such as:

  • being overweight
  • eating too much salt and not enough fruit and vegetables
  • not exercising enough
  • consuming too much alcohol or coffee (or other caffeine-based drinks)
  • smoking
  • not sleeping enough or having disturbed sleep
  • being older than 65
  • having a relative with high blood pressure
  • being from black African or black Caribbean descent
  • living in a deprived area

What Are The Risks Of Hypertension?

High blood pressure puts strain on your blood vessels, heart, and other organs such as the brain, kidneys, and eyes. Persistent high blood pressure can raise your risk of a variety of serious and potentially life-threatening health problems, including:

If you have high blood pressure, even a modest reduction can help you avoid these diseases. The only way to know if you have hypertension is to get a blood pressure check.

How To Lower Your Blood Pressure

Your blood pressure is determined by a variety of factors, including your diet, weight and exercise regime. If you have high blood pressure, you can start lowering it right now by eating healthier and getting more active.

If you’re at risk of high blood pressure, making healthy lifestyle modifications may help reduce your chances of developing it and help lower your blood pressure if it’s already elevated.

While healthcare professionals can help you keep your blood pressure at a safe level by recommending lifestyle changes and medicines, not everyone is the same. What works best for one person may not work for someone else so it’s important to consult a healthcare professional about the best treatment for you.

Using The NHS Blood Pressure Checks Service

The introduction of this service will support the work that Primary Care Networks (PCNs) will be undertaking on CVD prevention and management under changes to the PCN Directed Enhanced Service (DES). The DES requires PCNs to improve their diagnosis of patients with hypertension and in line with NICE guidance must ensure that appropriate follow-up activity is completed.

Working proactively with community pharmacies will enable PCNs to increase access to blood pressure checks for their patients through the hypertension case finding service. In 2022/23, PCNs must ensure that the necessary mechanisms for sharing information with community pharmacies are in place. This includes a process for accepting and documenting referrals between pharmacies and GP practices.

Before deciding on providing the service, pharmacy contractors must read the requirements which are included in the service specification. Anyone who wants to participate must notify NHSE&I that they intend to provide the service by registering through the NHS Business Services Authority’s (NHSBSA) Manage Your Service (MYS) application.

Hypertension Service Stages And Blood Pressure Checks

The NHS Blood Pressure Checks Service has two stages:

  1. Identify people at risk of hypertension and offer blood pressure measurement (a ‘clinic check’
  2. Where clinically indicated, offer 24-hour ambulatory blood pressure monitoring (ABPM).

The blood pressure test results will be shared with the patient’s GP to inform a potential diagnosis of hypertension. Contractors who want to provide the service must perform both stages where clinically required.

Which Blood Pressure Meters Should Contractors Use?

In preparing to provide the service, pharmacies must purchase or rent equipment for each of the two stages referred to as the Clinic blood pressure check and 24-hour ABPM.

If they already have the necessary equipment, they need to ensure it meets the required standards. All equipment that will be used in the service must be validated by the British and Irish Hypertension Society (BIHS).

As such, pharmacies must use a ‘normal’ BP meter and an ABPM from these two BIHS lists; Validated BP Monitors for Home Use and Validated BP Monitors for Specialist Use.

Who Is Eligible For The Blood Pressure Checks Service?

  • Adults 40 years or older who do not have an existing hypertension diagnosis
  • At the pharmacist’s discretion, patients under the age of 40 who request the service since they have a recognised family history of hypertension
  • Patients between 35 and 39 years old who have been asked about or requested the service at the pharmacist’s discretion
  • Adults specified by a GP who require blood pressure measurement (clinic and ambulatory blood pressure checks.

What Is Regarded As High Blood Pressure?

Blood pressure is recorded using two numbers; systolic pressure (higher number) and diastolic pressure (lower number). Systolic pressure is the force at which your heart pumps blood around your body while diastolic pressure measures the resistance to the blood flow in the blood vessels. Both are measured in millimetres of mercury (mmHg).

Everyone’s blood pressure will vary slightly so what’s considered low or high for one person may be normal for someone else. With that in mind, using a general guide:

  • high blood pressure is 140/90mmHg or higher (or 150/90mmHg or higher if you’re over the age of 80)
  • ideal blood pressure is usually considered to be between 90/60mmHg and 120/80mmHg

If your blood pressure reading is between 120/80mmHg and 140/90mmHg, you may be at an increased risk of developing hypertension unless you take preventative steps.

Training For Pharmacy Staff

To support the NHS Blood Pressure Checks Service, Virtual Outcomes has developed a compelling course for pharmacy staff and pharmacists who will be responsible for delivering the service. For more information about the wide range of online training courses, simply visit the website or email us: info@virtualoutcomes.co.uk.

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