England Improve High Blood Pressure Control

UK keeps blood pressure in check

A national health survey reported in Hypertension: Journal of the American Heart Association shows significantly increased awareness, treatment and control of high blood pressure (HBP) in England.

Researchers evaluated and compared blood pressure management in 2006 and 2003, focusing on heart disease and its prevention. They analyzed 7,478 people ages 16 and older. This included 3,314 men and 4,164 women. The average age was 47 years.

Their findings are encouraging. Among those receiving treatment for high blood pressure, more were found to have achieved good control in 2006 compared to 2003. In 2006, 53 percent of women and 52 percent of men achieved control of high blood pressure. In 2003, only 44 percent of women and 48 percent of men in 2003 had achieved good control.

It was also found that more people were aware of high blood pressure. This is encouraging. Awareness is the first step to being diagnosed. The percentage of those aware is up to 71% of women and 62% of men in 2006 as compared to 64% of women and 60% of men in 2003.

This awareness seems to have led to more being treated for high blood pressure. The researchers found that in 2006, 62% of women and 47% of men were being treated for their HBP as compared to 52% of women and 43% of men in 2003.

Not only did they find that more are being treated, but more have achieved good high blood pressure control. They found that 32% of women and 24% of men achieved good control in 2006 as compared to 23% of women and 21 % of men in 2003.

Researchers also found that more patients (greater than 60%) were being treated using two or more anti-hypertensive medications compared to 56 percent in 2003.


In April 2004, the UK introduced the Quality and Outcomes Framework (QOF) in the new General Medical Services (GMS) contract. In this pay-for-performance system, general practitioners receive compensation for achieving various clinical targets, with points and payments awarded according to the level of achievement. Most practices with a GMS contract have participated fully.

A recent study on data from general practices from April 2004 to March 2007 has attributed improved blood pressure monitoring and control in the UK to the physician pay-for-performance incentives. One of the measured achievements is lowering blood pressure levels to less than 150 millimeters of mercury (mm Hg) systolic and less than 90 mm Hg diastolic.

It is felt that controlling blood pressure is a very cost-effective method of reducing the risk of heart attacks, strokes and deaths.

In an accompanying editorial, Sailesh Mohan, M.D., and Norm R.C. Campbell, M.D., of the University of Calgary, Canada, wrote: "It is critical to discern the impact of Performance for Pay on hypertension management so that other countries can assess the potential to improve hypertension management using this tactic. The basis for improved hypertension in England prior to and following the introduction for pay for performance requires more rigorous exploration."

The researchers note that despite improving trends, hypertension rates in England are far from the optimum and "more intensive efforts are clearly warranted to prevent and control hypertension so that a meaningful impact can be achieved in reducing hypertension-associated cardiovascular disease."

The Department of Health and the NHS Information Centre for health and social care funded the two surveys.

Other co-authors are: Moushumi Chaudbury, M.Sc., nutritionist; and Jennifer Mindell, M.B., B.S., Ph.D. Individual author disclosures are available on the manuscript.

Hypertension: Journal of American Heart Association