High Blood Pressure
High blood pressure (hypertension) is one of the causes of premature mortality and morbidity that is most amenable to treatment. It is a major risk factor for stroke, heart disease, heart attacks, kidney disease and premature death (National Institute for Health and Care Excellence, 2011).
Risk factors for hypertension include being overweight or obese, physical inactivity, having a family history of high blood pressure or diabetes, and being diabetic (National Institute for Health and Care Excellence, 2011). The prevalence of high blood pressure in the registered population of York had been steadily rising to a level of 12.4% in 2008-2009. This value remained static through 2009-2010 and increased to 12.5% in 2010-2011, but has always been significantly below the England average of 13.5% (Health & Social Care Information Centre, 2012).
However, the Association of Public Health Observatories has produced modelled estimates for the prevalence of high blood pressure, suggesting that there may be an undiagnosed prevalence of approximately 11.5% (Public Health Observatories). Whilst this is a modelled estimate and needs to be treated with caution, increased awareness and identification of individuals with high blood pressure could account for the steady rise in recorded prevalence.
Using Quality and Outcomes Framework targets for the NHS Vale of York Clinical Commissioning Group, 80% of those diagnosed with high blood pressure are treated to achieve the target blood pressure in 2010-2011 (Health & Social Care Information Centre, 2012). This is similar to the England average of 79%.
Whilst this achievement needs to be acknowledged, the target blood pressure is higher than the evidence-based clinical standard and therefore there is potential room for improvement. In addition, 85% of those individuals who were diagnosed as having high blood pressure in 2010-2011 were assessed with regard to their risk of developing cardiovascular disease and received advice regarding healthy lifestyle choices (Health & Social Care Information Centre, 2012).
Given that high blood pressure is associated with the development of cardiovascular disease and is amenable to lifestyle modification in terms of physical activity, stopping smoking and weight loss it would be welcome to see even further improvements in these indicators.
The recorded prevalence of diabetes has increased slightly since 2008 to 4.4% of the registered population of York over the age of 17 years during 2010-2011 (Health & Social Care Information Centre, 2012). The England average was 5.5%. The crude admission rate attributed to diabetes York in 2009-2010 was 1.2 per 1000 registered population, which was similar to the England average of 1.1 (Public Health England).
During 2010-2011, 51.0% of those individuals diagnosed with diabetes had good long-term blood sugar control (as measured by glycated haemoglobin) though this was below the England average of 54.2%. The monitoring and control of an individual with diabetes’ blood pressure is also important for preventing long-term complications. Locally, the proportion of diabetic patients who experienced good blood pressure control (78.2%) was lower than the England average (81.2%).
Diabetes is the leading cause of blindness before old age and the effects can be mitigated by early intervention (National Collaborating Centre for Chronic Conditions, 2008).
The Royal National Institute for the Blind estimate that 40% of people with type 1 diabetes and 20% of people with type 2 diabetes will develop diabetic eye disease during their lives. A national diabetic eye screening programme is in place to identify early changes which may be amenable to treatment.
In patients registered with GPs in the NHS Vale of York Clinical Commissioning Group, 94.3% had undergone diabetic eye screening in the 15 months prior to 31st March 2011. This compares well to the England rate of 91.6% and has increased from the 2010 rate for the commissioning group of 94.0% (Public Health England).
The prevalence of diabetes appears to have increased slightly, which could be attributed to a true increase in the prevalence, or may be due to increased awareness of the condition amongst the general population and case-finding activities within the NHS.
It would appear that improvements could be made with regard to blood sugar and blood pressure control amongst those patients diagnosed with diabetes.