Case study: Hypertension at home
Across Hampshire and Isle of Wight our team of clinical leads have been working with primary care colleagues and partners around the local system to make our area an exemplar in blood pressure management, and in doing so, helping prevent hundreds of patients from suffering strokes and heart attack.
Through the NHS England BP@Home programme, we have provided more than 6000 home blood pressure machines throughout the Hampshire and Isle of Wight Integrated Care System (ICS), enabling those most at risk of hypertension to better manage their blood pressure at home alongside the support of their local GP practice.
Although rates of premature death from cardiovascular disease (CVD) have been falling over the last few decades, it still accounts for a quarter of all premature deaths in the UK. However CVD is largely preventable, the risk factors well known and the solutions affordable and accessible.
Those in the most deprived communities are twice as likely to die from CVD compared to those in the most affluent areas so we have been initially targeting areas most at need and those practices with the highest rate of uncontrolled hypertension.
Although many patients already monitor their blood pressure at home, locally we have been fortunate to be part of the first three waves of the NHS England and NHS Improvement programme and been able to share learning throughout the system.
We looked at public health data to identity those GP practices whose patients would gain the greatest benefit from the at home blood pressure machines and our most deprived areas locally.
During the pandemic, our focus on managing blood pressure was heightened further. Not only are those with high blood pressure and CVD at a greater risk of severe infection and even dying from COVID-19, but the need for patients to be able to look after their own health at home was ever more important.
Through using the at home blood pressure monitoring machines patients can keep track of their own blood pressure readings and send these onto their GP; negating the need for a visit to the practice. This not only reduces GP workload but also puts patients more in control of their own health.
Monitoring blood pressure at home not only improves health outcomes for patients, it also results in better value for money to the local NHS. By catching any higher readings at an early stage we are able to support patients in the community and help to reduce the risk of hospitalisation from stroke or heart attack. This also supports GP practice workload as reduces the need for long term follow up for these patients.
“I had high blood pressure and so I bought myself a blood pressure machine so I could take my readings at home and make sure I was keeping well.
“It’s so much easier doing this at home as you’re in a calm atmosphere and can take it at times that suits you.”
“The effects of hypertension can result in heart attacks or strokes so I think it’s better to stay in control of it.”
Our clinical leaders were invited by NHS England and NHS Improvement to share our local learning on the national stage; one of only two areas across the country to do so and through publicising the programme we have also been encouraging GPs outside of the current pilot area to spread the word to their patients about the benefits of purchasing their own blood pressure machine.
By monitoring their own blood pressure at home, patients can be more in control of their own health and share the readings with their GP quickly and easily, reducing their need to physically go into the practice and catching any higher blood pressure readings early, to be able to gain additional support from their GP.
The programme has also simplified processes for GPs managing patients with high blood pressure, so they are better able to support those most in need. We recognise that this has been an exceptionally busy time for general practice, however it is worth noting that once implemented the use of blood pressure monitoring at home reduces the appointment times hypertensive patients need. They can be managed more remotely through uploading their stats for their GP to review and discuss any concerns or arrange an appointment if necessary.