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High Blood Pressure (HBP)
September 2014
High blood pressure (HBP), also known as hypertension, is one of the main, preventable causes of illness and
premature death in the UK. HBP is usually defined as 140/90 mmHg or above. However, the level of blood
pressure at which treatment is given varies depending on whether there are other risk factors affecting a
particular patient.
HBP is an integral factor in the development of stroke, chronic kidney disease (CKD) and cardiovascular
disease (CVD), a group of diseases of the heart and blood vessels.
HBP is by far the most common long-term condition in Islington, affecting 14,830 adults under the age of 75.
HBP disproportionately affects people from poorer backgrounds and BME (Black and Minority Ethnic) groups
as HBP risk factors are more prevalent in these communities, leading to health inequalities in the borough.
Key facts and figures
1 in 4
Islington adult residents have
high blood pressure 2012
32%
20,230
of people with high blood pressure are
from black and minority ethnic groups
adults in Islington have
diagnosed high blood
pressure 2012
2012
1%
11%
77%
of people with a long term
condition have never had their
blood pressure measured 2012
of people with high blood pressure also
have coronary heart disease, which is
the main cause of death in Islington 2012
of people with uncontrolled high
blood pressure are not on any
anti-hypertensive medication 2012
Key programmes and services
Programmes focus on the early identification and management of high blood pressure, and interventions to
reduce risk factors such as smoking, poor diet and lack of exercise.
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The NHS Health Checks programme aims to diagnose disease and manage cardiovascular disease and
its risk factors, including high blood pressure
Primary prevention programmes to reduce the risk factors for high blood pressure, such as Stop Smoking
services, weight management services and exercise referral programmes
Closing the Prevalence Gap is a locally commissioned service aiming to reduce the gap between
diagnosed and undiagnosed long-term conditions, including high blood pressure.
Key measures for reducing inequalities
The ‘wider determinants of health’ are the social, economic and environmental conditions which influence the
health of individuals and populations. Building upon the existing work of Islington Councils, Islington CCG and
other partners, the recent transition of Public Health into local government provides an opportunity to consider
what more can be done locally to reduce health inequalities by tackling the wider determinants of health.
Alongside a focus on influencing the determinants of health, we are working to better target our services
aimed at preventing and managing long term conditions. To reduce health inequalities we work to improve
access and increase uptake for people in different age, ethnic, geographical and gender groups who may be
missing out.
 evidencehub.islington.gov.uk
Key population groups
The risk of developing high blood pressure increases as people get older. People from Black African or
Caribbean backgrounds, and those with a family history of high blood pressure, are also at an increased risk.
‘At risk’ groups


People aged 65 +
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People from African or
Caribbean ethnic groups
People with a family history
of high blood pressure
What are the risk factors for high blood pressure?
In most cases, the specific cause of high blood pressure is unknown, but various factors can increase the risk
of developing the condition: age (the risk increases as you get older), a family history of high blood pressure
(the condition seems to run in families), being of Black African or Caribbean origin, a diet high in salt, lack of
exercise, being overweight, smoking, and drinking alcohol above safe drinking levels.
About 10% of high blood pressure cases are the result of an underlying medical condition. These cases
are called ‘secondary high blood pressure’. Common causes are kidney disease and diabetes. High blood
pressure can also be caused by some hormonal problems.
Age
People over 65 years of age have a 90% chance of developing high blood pressure by the time they reach
80.
Smoking
People who smoke are at a higher risk of developing high blood pressure. Smoking damages the lining of the
arteries, meaning there is more resistance to blood flow, increasing the pressure in the arteries.
Diet
Having a diet high in salt is a key risk factor for high blood pressure, as are the consumption of alcohol and
caffeine based drinks, including coffee.
Physical inactivity
A lack of physical activity, and in particular inadequate levels of aerobic activity, are linked to higher
incidence of high blood pressure.
Obesity
Being overweight or obese increases the risk of having high blood pressure.
Clinical Risk Factors
High blood pressure is particularly common in people with kidney disease. The kidneys play an important role
in controlling blood pressure.
High blood pressure is more common in people with diabetes. Around 3 in 10 people with Type 1 diabetes
and around 8 in 10 people with Type 2 diabetes develop high blood pressure at some stage.
 evidencehub.islington.gov.uk
THE ISLINGTON PICTURE
We gather information from GPs and from patient surveys to plan our services and provisions. This enables
us to get the right treatment to the right people.
Disease modelling suggests that many people with high blood pressure, do not know that they have it. This is
not surprising as there are usually no symptoms. It is however important to diagnose high blood pressure
early so that people can access treatment sooner, reducing the impact of HBP on their long-term health.
Diagnosed
prevalence
Expected
prevalence
20,800
25,900
10.8%
24.2%
Numbers
diagnosed
Estimated numbers
undiagnosed
Who has high blood pressure?
High blood pressure prevalence by age and sex,
2012
higher rate of HBP in the most deprived areas of
Islington than the least deprived areas 2012
Men
80%
Women
70%
60%
50%
40%
30%
Most
Least
deprived deprived
Islington average
90%
Deprivation quintile
Percentage of people
100%
17%
20%
10%
0
50
100
Indirectly standardised ratio
0%
<40
40-59
60-79
32%
80+
Age group
150
of people with diabetes are from BME groups. This
is significantly higher than the percentage of BME
people in the Islington population (28%) 2012
What other long-term conditions do people with high blood pressure have?
HBP & HBP &
3 LTCs 4+ LTCs
7%
4%
HBP
only
42%
0%
20%
HBP
&1
LTC
31%
40%
60%
20,233 people
diagnosed with high
blood pressure
HBP
&2
LTCs
15%
80%
Diabetes
Mental
5,243
Health
26%
3,408
17%
100%
Percentage of people
58% of people diagnosed with HBP, also have at
least one other diagnosed long-term condition
(LTC). 15% of people have two LTCs, and 7% are
living with three or more diagnosed LTCs 2012
Source: Islington GP Public Health dataset, 2012
CKD
2,656
13%
CHD
2,187
11%
26%
of people diagnosed with high blood pressure also
have a diagnosis of diabetes 2012
 evidencehub.islington.gov.uk
Prevalence
Expected and recorded prevalence of high blood pressure, by GP practice, in Islington's registered
population aged 16+ 2011/2012
Diagnosed prevalence of high
blood pressure varies by GP
Practice, from 7% to 20%.
50%
45%
Prevalence
40%
35%
In all GP practices in
Islington, diagnosed
prevalence of high blood
pressure is significantly lower
than expected prevalence.
30%
25%
20%
15%
10%
5%
I
New North Health Centre
The Family Practice
Barnsbury Medical Practice
Roman Way Medical Centre
Bingfield Street Surgery
Pine Street Medical Practice
Dartmouth Park Practice
The Rise Group Practice
Dr Moneeb's Surgery
Andover Medical Centre
St John's Way Medical Centre
Elizabeth Avenue Group Practice
GP practice
Expected prevalence
Recorded prevalence significantly lower than expected prevalence
Partnership Primary Care Centre
The Medical Centre
Goodinge Group Practice
Mitchison Road Surgery
Archway Primary Care Team
The Miller Practice
Sobell Medical Centre
Dr Kateb & Partner
Mildmay Medical Centre
River Place Group Practice
The Village Practice
The Northern Medical Centre
City Road Group Practice
Hanley Primary Care Centre
Amwell Group Practice
St Peter's Street Medical Practice
Ritchie Street Group Practice
Holloway Medical Clinic
Highbury Grange Medical Centre
Stroud Green Medical Clinic
Dr Ko's Surgery
Killick Street Health Centre
Clerkenwell Medical Practice
Islington Central Medical Centre
0%
Note: Wedmore Gardens Surgery is
not included in the ERPHO modelled
estimates of prevalence owing to its
small list size, therefore this is not
displayed on the graph.
Source: Islington
GP Public health
dataset, 2012
Islington expected prevalence (24.3%)
Islington recorded prevalence (10.6%)
95% Confidence Intervals
Management
Diagnosing people with high blood pressure allows for appropriate treatment and interventions to be given.
People with a long term condition may be at increased risk of high blood pressure, and should have their
blood pressure measured regularly.
Blood pressure recording in people with:
No long term conditions
33,574
22%
At least one long term condition
55,372
37%
In the past
15 month
485
6,266 1%
16%
Not in the
past 15
months
Never
recorded
62,317
41%
31,402
82%
In the past 15
months
Not in the past
15 months
Never
recorded
One way of managing uncontrolled high blood pressure is through anti-hypertensive medication. However,
77% of people with uncontrolled high blood pressure have not been prescribed anti-hypertensives.
Percentage of people with uncontrolled
high blood pressure
Percentage of people with uncontrolled high
blood pressure prescribed anti-hypertensives
1,907
23%
8,356
41%
11,877
59%
Not prescribed
antihypertensive
medication
Uncontrolled
Controlled
Source: Islington
GP Public Health
dataset, 2012
 evidencehub.islington.gov.uk
6,367
77%
Prescribed
antihypertensive
medication
Note: data on medications is
not comparable to the previous
HBP factsheet (Oct 2012)
WHAT DO LOCAL PEOPLE THINK ABOUT THE ISSUE?
It is important to understand peoples’ views and experiences of high blood pressure, in order to prevent and
manage the condition effectively.
Healthwatch Islington carried out a survey of some of the Islington residents who have a long-term condition.
From this research they identified that people with long-term conditions really value peer support as well as
being able to access reliable information regarding their own condition. Respondents interviewed were keen
to be able to self-manage their condition where possible but also identified the need to be able to easily
access health professionals during times of need.
WHAT WORKS?
High blood pressure is largely managed in primary care. Early identification of high blood pressure and
management with anti-hypertensive treatment has been shown to be effective in managing HBP. Trials of
anti-hypertensive treatment have also confirmed a significant reduction in the incidence of stroke and
coronary heart disease in patients with high blood pressure.
Primary prevention
Interventions to reduce the prevalence of risk factors in the
general population, including smoking cessation, increasing
physical activity and healthy eating, and particularly reducing salt
intake.
Case finding and early
diagnosis
Identification and assessment of patients with high blood
pressure, for example through the NHS Health Checks
Programme and management of key risk factors through
appropriate advice on smoking, diet, and physical activity.
Management and
control
Management of high blood pressure in primary care to
prevent the development of cardiovascular disease, for example
heart attacks and strokes. Management includes supporting people to make the necessary lifestyle changes, such as stopping
smoking, having a healthy diet and exercising more.
Management also includes pharmacological treatment with antihypertensive drugs.
Future need
Estimated projections of high blood pressure prevalence are not available. The estimated prevalence of
high blood pressure each year has remained relatively static and therefore the proportion of people living
with high blood pressure is not expected to increase significantly. However population projections for
Islington suggest an increase in the population over time, which we can expect to lead to the number of
people living with high blood pressure to increase.
 evidencehub.islington.gov.uk
Targets and outcomes
There is a national target for the delivery of the NHS Health Checks programme. There are also a number of
targets relating to high blood pressure (hypertension) in the Quality Outcomes Framework (QOF) which
monitor performance of general practice.
Document or strategy that target
is taken from
Target
Deadline for
target
To offer an NHS Health Check to 20% of the
eligible population every year
NHS Health Check programme
standards: a framework for quality
improvement, 2014
April 2015
There are Quality Outcomes Framework
indicators for hypertension, including:
The Quality and Outcomes Framework
April 2015
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Establishing and maintaining a register of
patients with diagnosed hypertension
The percentage of patients with hypertension,
in whom the last blood pressure (measured
within nine months) is 150/90 or less. Target:
45-80%
National and local strategies
High blood pressure, as the leading risk factor for cardiovascular disease and CVD mortality, is a local and
national priority. Actions to identify high blood pressure earlier and offer timely treatment are included in key
national and local strategies and programmes.
National Strategies
Local Strategies
National Service Framework for CHD, 2000-2012
Health and Wellbeing Strategy, 2013-2016
The National Service Framework for Coronary Heart
Disease (NSF CHD), published in March 2000, set
out to reduce CHD and stroke related deaths by
40% over 10 years. This target was met in five
years. The framework identifies the treatments
proven to be the most clinically effective & represent
the best value for money. The framework also seeks
to promote the integration of care for patients.
One of three key priorities identified by Islington’s Joint
Health and Wellbeing strategy is to improve the case
finding and management of long-term conditions,
including high blood pressure.
NHS Health Check Programme
The strategy includes recommendations to reduce the
gap between recorded and expected prevalence for
CHD, as well as recommendations to tackle the major
risk factors of cardiovascular disease; high blood
pressure, high cholesterol, deprivation and lifestyle
factors such as smoking, poor diet and a lack of
physical activity.
The NHS health check programme is a national
cardiovascular screening programme which aims to
prevent coronary heart disease, diabetes and
chronic kidney disease. It includes finding people
with undiagnosed high blood pressure, so that the
condition can be treated.
Closing the Gap: Tackling Health Inequalities in
Islington, 2010-2030
Islington’s Health Inequalities Strategy highlights the
need for action to reduce early deaths due to CHD.
The national programme targets health checks to
eligible patients aged 40-74 once every five years.
Islington Public Health is responsible for the local
implementation of the programme and due to need
offers a check to anyone aged 35-74.
 evidencehub.islington.gov.uk
What is being done locally to address the issue?
Primary Prevention
There are a number of services in Islington are in place to improve lifestyle and health behaviours and help
prevent long term conditions including hypertension. These include:
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Stop Smoking Services. These are available in many GP practices, pharmacies and community locations
and are available to anyone living or working in Islington who smokes.
Weight Management Services for people aged 18+ with a body mass index (BMI) >30 (>27.5 South
Asian).
Exercise on Referral services for individuals at high risk of CVD or diabetes or those diagnosed with a
long-term condition.
Alcohol Screening & Advice is available to all residents via primary care providers and
dontbottleitup.org.uk an alcohol self-help website provided by Islington Public Health. Structured expert
support is also available from Islington Community Alcohol Service.
Broad programmes of work in collaboration with multiple stakeholders to encourage increased levels of
physical activity and healthy eating in the general population.
Identification and treatment of high blood pressure in primary care
NHS Health Checks programme: This locally commissioned service is designed to case find and prevent
heart disease, stroke, diabetes and kidney disease by identifying and treating people at high risk through
targeting 35-74 year olds. During the Health Check individuals are also offered lifestyle advice.
Between 1st April 2013 and 1st June 2014 39,319 checks have been delivered in Islington in general
practices, pharmacies and outreach community centres.
Health Checks have been proved to be effective for case-finding of CHD in Islington; between April 2011 and
March 2012 51 new diagnoses of CHD and Myocardial Infarction (MI) were made following a health check.
Closing the prevalence gap: The aim of this locally commissioned service is to reduce the gap between
diagnosed and undiagnosed prevalence of a number of long-term conditions including high blood pressure.
GP practices proactively identify those people on their practice register who have had a raised blood
pressure reading but have not had any follow-up thereafter. Identified individuals are then followed up,
managed in primary care and referred into lifestyle services as appropriate.
 evidencehub.islington.gov.uk
Further information
Further information on this topic can be found at the following locations
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Blood Pressure Association, 0207 882 6218
www.bloodpressureuk.org
British Heart Foundation, 0300 330 3311
www.bhf.org.uk
The Stroke Association, 0303 3033 100
www.stroke.org.uk
Hypertension. Clinical management of primary hypertension in adults. NICE, 2013
http://guidance.nice.org.uk/CG127/NICEGuidance
The NHS Health Checks Programme http://www.healthcheck.nhs.uk/
NHS Islington (2011) Annual Public Health Report 2011: Extending Life in Islington
http://www.islington.gov.uk/publicrecords/library/Public-health/Quality-and-performance/Reporting/2012
-2013/(2013-01-18)-APHR-2011-Full-report.pdf
Coronary Heart Disease: national service framework for coronary heart disease—modern standards
and service models. Department of Health, 2000.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/
DH_4094275
NHS Islington/Islington Council (2010) Closing the Gap. Tackling Health Inequalities in Islington 20102030 http://www.islington.gov.uk/publicrecords/library/Democracy/Quality-and-performance/
Reporting/2011-2012/(2012-03-03)-NHS-Islington.pdf
Contact information:
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Weight Management: www.aquaterra.org/activities/aquaterra-rebalance-weight-management
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Alcohol Screening & Advice: www.dontbottleitup.org.uk or call 0808 800 0019
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Stop Smoking Services: www.smokefreeislington.nhs.uk/ or call 0800 093 9030
About the Evidence Hub
The Evidence Hub is a partnership between the local NHS and Islington Council that brings together
information held across different organisations into one accessible place. It provides access to evidence,
intelligence and data on the current and anticipated needs of the Islington population and is designed to be
used by a broad range of audiences including practitioners, researchers, commissioners, policy makers,
Councillors, students and the general public.
This profile has been produced by Polly Reynolds, Assistant Public Health Strategist and signed off by Liz
Brutus, Assistant Director of Public Health.
For more information contact [email protected] or call 020 7527 8086.
© Islington Public Health
 evidencehub.islington.gov.uk