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Health Matters: Combating high blood pressure with the NHS Health Check

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Cardiovascular disease (CVD) affects around seven million people in the UK and is the most important cause of preventable, early disability and death, affecting individuals, their families and communities.

High blood pressure contributes to half of all strokes and heart attacks, as detailed in the latest edition of Health Matters.

Millions of people are living with undiagnosed and untreated high blood pressure, which increases their risk of developing heart attack and stroke, as well as heart failure, kidney disease and dementia.

Missing or delaying these diagnoses has serious consequences for the wellbeing of individuals and their families as well as cost implications for them and the health and social systems that support them.

But they are also often preventable – for example, treatment of high blood pressure is very effective: for every 10mmHg reduction, the risk of having a heart attack or stroke is reduced by 20%, with similar and additional reductions from reduced cholesterol in people at increased cardiovascular risk.

The NHS Health Check programme addresses the top seven causes of preventable morbidity and mortality:

  • high blood pressure
  • smoking
  • cholesterol
  • obesity
  • poor diet
  • physical inactivity
  • alcohol consumption.

It offers a chance for action both nationally and locally to address these health problems.

We know that CVD is one of the conditions most strongly associated with health inequalities. With CVD deaths being three times higher among people in the most deprived communities compared to those in the most affluent.

The NHS Health Check programme is not just reaching the “worried well”. People from deprived communities are more likely to have a check than those from the most affluent communities.

It is also reaching ethnic groups at higher risk of having a heart attack or stroke, the programme offers a real opportunity to impact on health inequalities.

The importance of the NHS Health Check programme

The Global Burden of Disease Study highlighted the relationship between key behavioural and physiological risk factors and the leading causes of premature morbidity and mortality, reinforcing the UK’s need for action in tackling preventable death and disability.

With increasing obesity, previous improvement in cardiovascular health is slowing and the need for national action is urgent.

Modelling undertaken by the Department of Health estimates that, each year, the NHS Health Check programme offers the potential to prevent over 4,000 people from developing diabetes, save at least 650 lives, prevent 1,600 heart attacks and strokes, and detect at least 20,000 cases of diabetes or kidney disease earlier.

And an impact assessment done by Department of Health in 2008 estimated that vascular checks could produce an annual average benefit of £3.6bn.

The NHS Health Check underpins other local and national lifestyle service (e.g. NHS Diabetes Prevention Programme), by providing a mechanism for identifying people who would benefit from accessing them.

The programme is there to support GPs and the wider primary care workforce as a systematic approach to case-finding and delivery of evidence based interventions recognised by National Institute of Health and Care Excellence.

The Check is also central to ensuring people get appropriate clinical management and is recognised in the NHS RightCare cardiovascular disease optimal value pathway, as a key aspect of the prevention pathway.

Recent NHS Health Check findings

The recent findings from the Queen Mary University independent study compared NHS Health Check attendees with a matched group of non-attendees from 2009-2014 in three of the country’s most ethnically diverse and socially deprived areas.

The three London areas in the study; City & Hackney, Tower Hamlets, and Newham, serve disadvantaged populations with higher CVD risk.

In these areas, coverage of the NHS Health Check increased year on year to 85% compared with around 50% nationally. Attendance was higher for South Asian patients, older patients and those in more deprived sections of the population.

Among the attendees, 50% more new cases of hypertension were diagnosed in the NHS Health Check attendees compared to non-attendees. Furthermore, 30 per cent more new cases of diabetes and 80 per cent more new cases of chronic kidney disease were diagnosed than among non-attendees.

The benefits of NHS Health Checks shown in this study add to the impact of the programme and are of public health importance. Additionally, the treatment of hypertension, diabetes and kidney disease, as a result of attending an NHS Health Check, would further reduce CV events.

Increasing uptake of NHS Health Check

There has been a significant reduction in deaths from CVD in the past 20 years, despite this; it remains the second highest cause of death and ill health in England.

Thousands more people could live healthily for longer, because early-stage disease is detected during a Check.

We can do more to increase the number of people having a Check and ensure they gain access to the appropriate clinical or lifestyle support.

The recent Queen Mary study shows that there is scope and justification to improve the NHS Health Check programme. Other recent studies have found similarly improved management of risk factors among NHS Health Check attendees.

However, rates of coverage are currently highly variable across the country and increasing uptake of the NHS Health Check is an important challenge for the coming year.

Recent studies confirm that higher levels of coverage are achievable and would lead to substantial gains for public health.

We need a system-wide response, with local authorities, the NHS and PHE working together to improve delivery so that we achieve outcomes similar to East London.

There are likely to be a number of reasons to why people aren’t having their NHS Health Check. PHE is currently undertaking several studies to increase understanding of how to communicate with different people.

These studies evaluate different invitation methods i.e. text messages, letters and phone calls as well as different approaches to increasing patient interest and awareness through marketing (e.g. One You, heart age tool, NHS Choices).

Please read the latest edition of Health Matters, looking at how we can combat high blood pressure, for more information.

Health Matters
Health Matters is a resource for professionals which brings together the latest data and evidence; makes the case for effective public health interventions and highlights tools and resources that can facilitate local or national action. Visit the Health Matters area of GOV.UK or sign up to receive the latest updates through our e-bulletin. If you found this blog helpful, please view other Health Matters blogs.

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