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Hypertension Programme

Hypertension is a major preventable cause of cardiovascular disease and all-cause death. Lowering blood pressure can substantially reduce premature morbidity and mortality. 

A recent meta-analysis identified a significantly reduced risk of major cardiovascular events, including coronary heart disease, stroke and heart failure for every 10mmHg reduction in systolic blood pressure [1]. The Global Burden of Disease study shows that hypertension is the leading risk factor for deaths in Cambridgeshire and second leading risk, after smoking, in Peterborough.

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The national picture can be seen here 

The Public Health England ambition is that 80% of people on the hypertension register are managed to 140/90 mmHg or below. Currently in CPCCG it is estimated that 57% of people on the hypertension register are managed to this level and 78.4% of people on the register are managed to 150/90 mmHg. See here.

There is a range of variability in terms of management of hypertension across CPCCG. The QOF data from 2017_18 shows successful management ranges from practices where 9% of patients on the hypertension register have a most recent blood pressure reading above 150/90 mmHg to practices where up to 35% of patients on their hypertension register are not managed to 150/90 mmHg. 

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To see how an individual practice compares to other practices please email sue.stephenson4@nhs.net

Brief reviews of the literature have been used by CPCCG to develop driver diagrams that explore why detection and management of hypertension may be suboptimal and possible interventions to improve this. 

HTN Control Driver diagram and Detection Driver diagram

CVD is a driver of inequalities, PHE analysis shows that 40% of amenable CVD deaths occur in the three most deprived deciles in England [8]. In particular, people with severe mental illness have a higher risk of developing CVD compared to the general population, with their CVD risk presenting at an earlier age. They have a higher risk of being overweight or obese or smoking. They may be less likely to respond to letters or reviews.