Hypertension
Introduction
Hypertension is the medical term for high or raised blood pressure. This is a condition where a person’s blood pressure is always too high. This pressure pushes against the arteries, stretching, hardening them and causing them to narrow, which makes it easier for fatty material to build up.1 This leads to the heart having to work harder to pump blood around the body.
Hypertension is a key risk factor for cardiovascular disease, which has been identified in the NHS 10-year plan as the single biggest area where the NHS can save lives through prevention, early detection and healthy lifestyle changes.
Blood pressure is measured by two numbers:
- Systolic pressure - The higher number. This measures the pressure against your arteries when the blood is pumping around your body.
- Diastolic pressure - The lower number. This measures the pressure in your arteries when your heart relaxes between beats.
For people aged 80 and under, blood pressure reading is usually considered to be high when:
- 140/90 or higher when checked by a health professional.
- 135/85 or higher when checked at home.
For people aged 80 and over, blood pressure reading is usually considered to be high when:
- 150/90 or higher when checked by a health professional.
- 145/85 or higher when checked at home.
Many people will not realise they have high blood pressure, as it does not usually cause symptoms. People with very high blood pressure may experience dizziness, sickness, headaches and other symptoms. If left untreated, hypertension can lead to other health conditions such as:
- Heart failure
- Kidney failure
- Vascular dementia
- Stroke
- Heart attack
Leading a healthy lifestyle and making even small changes can help with lowering blood pressure to a healthy level, such as:
- Having a healthy balanced diet
- Regular exercise (150 minutes per week is recommended)
- Maintaining a healthy weight
- Stopping smoking
- Avoiding too much alcohol (no more than 14 units over a week)
- Avoiding too much salt
Why is it important to Population Health?
Hypertension is important to population health for many reasons:
Hypertension is important for population health as it is the largest known risk factor for cardiovascular disease (CVD) and related disability,2 with CVD contributing to a quarter of all deaths in the UK. Around 80% of people with heart and circulatory disease have at least one other health condition.3
Consequences: Hypertension and poor cardiovascular health can lead to serious poor health, including strokes, heart disease, heart attacks and vascular dementia, and affects 1 in 4 adults, half of which are undiagnosed, or their blood pressure is uncontrolled.4 After smoking and poor diet, hypertension is the third biggest risk factor for disease and disability in England,5 and is responsible for more than half of all strokes and heart attacks.
Health Inequalities: People that live in low-income households and areas of deprivation, as well as people who are of black or black Caribbean descent, are at increased risk of having high blood pressure.
Risk Factors: Primary hypertension is responsible for over 90% of cases and is a preventable and largely a reversible condition. Making positive changes to the following risk factors can help prevent and reverse hypertension:
- Poor diet
- Exercise
- Smoking
- Excessive alcohol consumption
- Being overweight
Population approaches to support people to take control of their own health, in making healthy lifestyle choices, can positively impact the likelihood of developing hypertension. There are also non-modifiable risk factors that impacts a person’s likelihood of having hypertension such as:
- Age
- Gender
- Ethnicity
- Genetics
Secondary hypertension is caused by underlying conditions such as kidney problems and endocrine disorders, such as diabetes.6
Around 1 in 10 women develop high blood pressure in pregnancy, and this can increase the risk of long-term high blood pressure. Leading a healthy lifestyle during pregnancy and lowering the blood pressure of mothers within 6 weeks of birth reduces the long-term risk.7
Medication for blood pressure may also be prescribed if blood pressure is very high, there is an increased risk of heart attack or stroke, or blood pressure remains high despite healthy changes.
Burden: It is estimated that high blood pressure costs the NHS £2.1 billion a year, plus additional costs of medication and clinical time, with high blood pressure accounting for 12% of all visits to a GP.8 This figure increases when you consider the impact on wider society, not only of hypertension, but other conditions attributed to high blood pressure, such as coronary heart disease, kidney disease and dementia.
Economic Impact: It is estimated that reducing the average systolic blood pressure by just 5mmHg would save the NHS and social care spend £850 million over 10 years.9 Associated conditions such as CVD, account for approximately 1 million hospital admissions, leading to 5.5 million bed stays, at a cost of around £15.8 billion every year.10
The Derbyshire Population Health Approach
The Derbyshire Population Health Approach focuses on prevention, population health, evidence-informed practices, causes, and collaboration. It emphasises proactive measures to prevent health issues, tailors interventions to specific populations, incorporates evidence-informed practices, addresses underlying causes, and promotes collaboration for effective action.
When considering the topic of hypertension within The Derbyshire Population Health Approach:
• Prevention
Primary hypertension is preventable where measures to engage in healthy lifestyles are adopted. It is important to take steps to decrease the risk of developing high blood pressure in the first instance, and establish healthy behaviours in early years, that support lifelong healthy habits to reduce risk
Population information and messaging to help people make informed decisions about their diet and lifestyle are important, as small changes can have big benefits.
Engaging in national programmes such as the NHS Health Checks and BP testing (Know Your Numbers), help people to understand their blood pressure and seek support if needed. Local services, such as Live Life Better Derbyshire, can also offer support and services to stop smoking, increase physical activity, and weight management.
• Population
Primary hypertension is known to largely affect those in lower socio-economic groups, with those living in areas of higher deprivation being at a 30% increased risk of developing hypertension. Also, at higher prevalence of hypertension or uncontrolled blood pressure are men and women of black or black Caribbean descent. The public health approach to reduce known inequalities aims to support communities in accessing available services and Make Every Contact Count (MECC).
• Evidence
There is consistent evidence that informs a 10mmHg blood pressure reduction would reduce risks of stroke (27%), heart disease (17%), heart failure (28%) and all-cause mortality (13%).11 Being able to reduce the risk comes back to the modifiable risk factors that individuals can take responsibility for, and be influenced in. Current research informs that the Covid-19 pandemic caused significant disruption to the prevention and early diagnosis of CVD conditions through unattended and missed appointments, which is why CVD is now, once again, the leading cause of death in the UK.
• Causes
The causes of hypertension are familiar as the four main modifiable risk factors for public health, smoking, alcohol consumption, weight management and physical activity. There are other contributing factors such as stress, and hypertension related to secondary diseases such as diabetes. The population approach provides opportunity for support to positively influence those known causes, and be offered and delivered through various approaches locally, ensuring access and equability for all.
• Collaboration
Working together to deliver key messages and services across public health, NHS, local government, and voluntary services is key to a population approach. Members of the public need to receive consistent messaging and advice that instills confidence and trust to influence key behaviour changes, no matter who is delivering this information. Joined up working also provides opportunity to extend services wider into communities, supporting accessibility to those that could benefit the most.
Latest Derbyshire Data