Combatting hypertension in the community

As their clinical roles continue to evolve, we explore how community pharmacists can help with the prevention, detection and management of high blood pressure…

Hypertension represents a large disease burden in the UK and cardiovascular disease is one of the government’s health priorities. High blood pressure affects more than a quarter of the adult population and is estimated to cost the NHS well over £2 billion a year.

Community pharmacists are well positioned to address gaps in care of hypertensive patients. Targeted interventions by pharmacists have been proven to improve medicines use, the appropriateness of prescribing and management of hypertension.

Therefore, a joined-up work between GPs and pharmacy teams for early detection and management of hypertension can be hugely beneficial to public health and government expenditure. At least half of all strokes and heart attacks are associated with high blood pressure, which speak volumes about the human and financial costs that could be cut by tackling hypertension.

Community pharmacies, spread out across the country’s rural and urban communities, are a trusted and convenient first port of call for anything health related. In England, 96 per cent of the population can reach a community pharmacy within 20 minutes by walking or using public transport which increases up to 99 per cent in areas of highest deprivation, where people are more likely to have high blood pressure compared to the least deprived areas.

Diagnosis and management

This underpins the importance of effective diagnosis and management of high blood pressure in community pharmacies which can play a crucial role in combating health inequalities. The delivery of NHS health checks in community pharmacy has been advocated for a decade now to improve access in hard-to-reach populations, in an attempt to reduce health inequalities.

The NHS health checks – a systematic screening programme for patients aged between 40 and 74 years with no history of cardiovascular diseases – consists of questions about lifestyle factors and family medical history, as well as measurements of clinical parameters such as height, weight, BP, cholesterol and, where appropriate, blood glucose levels.

Community pharmacists are perfectly placed to help patients make positive lifestyle changes to reduce their risk of serious cardiovascular events. “We see a variety of people at all stages of their life – it’s about giving people the right information at the right time – picking up that someone’s got elevated blood pressure before they start to have symptoms means they’ve got the opportunity to do something about it early,” says Jessica Hall, people development manager at Well Pharmacy.

“During the global pandemic we can be so proud as a sector that we’ve remained open and continued to support customers and patients during the most difficult time. As a result, more people are turning to their local community pharmacy for advice and guidance on managing long term conditions as well as to support with them with minor ailments. We must continue to build on these relationships and shout about the valuable contribution we make.”

Medication advice and counselling – the key role of pharmacists – is crucial in the management of cardiovascular disease along with many other long term conditions in the community setting. Hall adds: “We’ve seen the role of the pharmacist develop over the last 12 - 18 months and it’s really important to stay up to date with key external announcements and updates from the NHS, regulatory and professional bodies as well as the wider healthcare landscape.

“Being clear on the role community pharmacy plays in the NHS Long Term Plan and staying abreast with the changes in the Community Pharmacy Contractual Framework will help you take advantage and have the opportunity to demonstrate the value of community pharmacy.”

Lifestyle advice

The National Institute for Health and Care Excellence (NICE) recommends lifestyle treatment for all with hypertension with good adherence can achieve dramatic blood pressure reduction. Although cardiovascular disease is one of the main causes of death and disability in the UK, it can often largely be prevented by leading a healthy lifestyle. In its latest guidance, NICE advises pharmacists should:

• Offer lifestyle advice to people with suspected or diagnosed hypertension and continue to offer it periodically.
• Ask about people’s diet and exercise patterns because a healthy diet and regular exercise can reduce blood pressure.
• Ask about people’s alcohol consumption and encourage a reduced intake.
• Discourage excessive consumption of caffeine-rich products.
• Encourage people to keep their dietary sodium intake low as this can reduce blood pressure.
• Do not offer calcium, magnesium or potassium supplements as a method for reducing blood pressure.
• Offer advice and help to smokers to stop smoking.
• Inform people about local initiatives by healthcare teams or patient organisations that provide support and promote healthy lifestyle change, especially those that include group work for motivating lifestyle change.

Medicine adherence

Once the patient in on medication, management and compliance is critical in treating and managing blood pressure, however drugs used in the treatment of cardiovascular disease mainly control the condition and are not a cure. That said, patient compliance goes hand-in-hand with non-pharmacological measures such as reducing risk factors including managing blood pressure, managing diabetes, increasing physical exercise, and quitting smoking.

With community pharmacies being an ideal and accessible site, pharmacy teams can use their knowledge of the local community and target the population or at-risk groups they might suspect of having high blood pressure or high cholesterol and refer them onto the appropriate treatment.

Applying their expertise around medication adherence and optimisation, they can make sure people are on the right medications. The majority of patients on anti-hypertensive drugs do not achieve their recommended target because of poor daily adherence with medication regimens and a lack of willingness to persist with medication use. However, community pharmacists can make a big difference in promoting patient adherence to medicines.

This feature also appears in the November issue of Pharmacy Business.