National programme -

Blood Pressure Optimisation

Transforming the prevention of cardiovascular disease

Close up of nurse working on an ipad

Managing blood pressure and cardiovascular risk

Optimising the clinical care and self-management of people with hypertension

Supporting primary care networks to implement a proactive care framework for hypertension


Transforming the prevention of cardiovascular disease

Heart attacks, strokes and other forms of cardiovascular disease (CVD) cause a quarter of all deaths in the UK. CVD is also a leading cause of morbidity and costs the NHS an estimated £9 billion a year and economy around £19 billion annually. And, as a major driver of health inequalities, it accounts for a quarter of the life expectancy gap between deprived and affluent communities.

Hypertension and high cholesterol are leading risk factors for CVD and are highly modifiable, with treatment substantially lowering the risk of CVD.

Despite this, both are underdiagnosed and undertreated. For example, around 30% of people with hypertension are unaware they have it and, of those who have been diagnosed with hypertension, around a third are not treated to target.

Blood Pressure Optimisation Programme (BPO) 

The AHSN Network is launching a national blood pressure optimisation programme which aims transform the prevention of CVD. The programme, which will run until March 2023, aims to transform the prevention of CVD by optimising the clinical care and self-management of people with hypertension.

Academic Health Science Networks (AHSNs) will support primary care networks (PCNs) in implementing the UCLPartners Proactive Care Framework for hypertension, part of the NHS Proactive Care @home programme. This will support primary care staff to optimise clinical care and self-management of people with hypertension through:

  • Risk stratification to prioritise which patients to see first;
  • Use of the wider workforce to support remote care and self-care;
  • Adapting framework pathways for local implementation;
  • Supporting patients to maximise the benefits of remote monitoring and virtual consultations where appropriate.

AHSNs will also support PCNs in identifying more patients with hypertension through case finding interventions and support Integrated Care Systems in reducing health inequalities by targeting 20% of the most deprived populations and other local priority groups.

To find out more about the South West AHSN’s work on Blood Pressure Optimisation, please contact Marie-Joëlle West, Programme Manager.

Size of the Prize

Size of the Prize is a new resource that UCLPartners has developed with The Health Economics Unit. 

For each Integrated Care System and Region in England, Size of the Prize shows on a single slide:

  • The impact of COVID: in disrupting treatment for people with hypertension. On average the proportion with optimally controlled blood pressure has fallen from 70% to under 50%.
  • The risk: how many strokes and heart attacks might result if that disruption is not rapidly corrected. Across England this number exceeds 27,000 in 3 years.
  • The ambition: how many additional heart attacks and strokes can be prevented in 3 years and what savings can be generated if more people have their treatment optimised – with 3 levels of ambition.

You can view Size of the Prize information for the South West, and our individual ICSs, on the UCLP website.

Core20PLUS5 – An approach to reducing health inequalities

Core20PLUS is a national NHS England and NHS Improvement approach to support the reduction of health inequalities at both national and system level. The approach defines a target population cohort – the ‘Core20PLUS’ – and identifies ‘5’ focus clinical areas requiring accelerated improvement.

You can find out more about the ‘Core20PLUS’ population groups being targeted, as well as the five areas of focus on the NHS’ website.

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