CVD prevention: detecting and treating hypertension

How NICE resources can support local priorities

Making the case for action

Around 5.5 million people in England have undiagnosed high blood pressure (hypertension) – a usually symptomless condition that substantially increases the risk of stroke, heart attack and dementia. Treatment reduces risk, but under-treatment is common among those who are diagnosed.

Recent analysis from NHS England and Public Health England (PHE) shows that optimal treatment for everyone with diagnosed high blood pressure could avert up to 9,710 heart attacks and 14,500 strokes, saving up to £274 million.

Most local partnerships identified preventing cardiovascular disease (CVD) as a priority in their plans. By working across larger populations, they can drive larger-scale improvements such as increasing access to blood pressure testing in the workplace, and working with local authorities and the third sector to provide NHS health checks in community settings.

The NHS Long Term Plan includes an ambition to prevent 150,000 strokes, heart attacks and dementia cases over the next 10 years by improving the detection and treatment of atrial fibrillation, hypertension and high cholesterol. To support this, a coalition led by Public Health England has agreed specific ambitions for detecting and managing these high-risk conditions (see Health matters: preventing cardiovascular disease).

The ambitions for hypertension are that by 2029:

  • 80% of the expected number of people with hypertension are diagnosed.
  • 80% of the total number of people diagnosed with hypertension receive treatment, according to the target in NICE guidelines.

We've published guidance and quality standards on hypertension, and tools to help with putting it into practice. Our guidance is aligned with the NHS England RightCare and Public Health England cardiovascular disease (CVD) prevention pathway and will support delivery of the national ambitions for blood pressure.

Use data about your area

Reviewing data on what’s happening in your area helps you compare how you're doing with other areas, and make decisions on how to improve care. These resources provide data related to CVD prevention, including hypertension:

  • CVD Prevention Packs aim to provide information for the CVD prevention project. The CVD prevention programme set 10 year ambitions focussing on the three CVD risk factors, hypertension, atrial fibrillation and dyslipidaemia.
Cartoon showing a blood pressure pump, heart and monitor


Finding the right information

Our guidance to help you with detecting and treating hypertension

Our guidance sets the standards for high-quality healthcare and encourages healthy living.

It can be used by the NHS, local authorities, employers, voluntary groups and anyone else involved in delivering care or promoting wellbeing.

The easiest way of finding all our guidance on hypertension is to go to our topic page on hypertension.

Our NICE Pathway on hypertension is an interactive flowchart that shows how everything we've published fits together. The following video explains how to use NICE Pathways.

Our quality standard on hypertension includes quality statements that describe high-quality care in priority areas for improvement. See how to use quality standards for more information.

Other key hypertension guidance

Medical technologies guidance: WatchBP Home A for opportunistically detecting atrial fibrillation during diagnosis and monitoring of hypertension.

Support for improving quality

We publish a range of tools and resources to help with putting our guidance and quality standards into practice. You can find these on the tools and resources tab for each piece of guidance or standard. 

Tools for hypertension include:

Our impact report on CVD prevention highlights the progress made by the healthcare system by implementing our guidance.

NICE indicators

We’ve developed a set of outcome indicators for hypertension. Visit our standards and indicators page to see the indicators for hypertension.

Indicators can be particularly useful to local partnerships when:

  • creating local performance dashboards
  • benchmarking performance against national data
  • developing local quality improvement schemes
  • measuring progress that local health systems are making on outcomes.

Hypertension indicators pack

NHS Digital has designed specifications and business rules to support electronic data extraction from clinical IT systems on our hypertension indicators in a similar way to indicators used in the quality and outcomes framework (QOF). For a quick summary, go to the indicators tab on the standards and indicators page, and click on the link for the hypertension indicator pack on the right of the screen. To receive a full pack containing all the specifications and business rules to support electronic data extraction, email indicators@nice.org.uk.

The Cheshire and Merseyside public health collaborative is using the pack to support local quality improvement work. Saving lives: Reducing the pressure is a strategy to tackle high blood pressure. It includes a practice-level dashboard to track progress.

Front cover of the NICE cardiovascular disease prevention impact report.

Read the NICE CVD impact report.

Read the NICE CVD impact report.

Shared learning case studies

The shared learning collection contains over 500 case studies showing how organisations around the UK have used our guidance and standards to improve the quality of health and social care services.

Systematic case finding of people with hypertension

In East Berkshire, the CCG’s medicines optimisation team helped all 48 practices to identify undiagnosed hypertension, using a systematic audit to find people who had hypertension or were at risk of developing it.

After 12 months, there was a 12% increase in the number of people diagnosed with hypertension, a significantly higher increase than in the previous 2 years (1% and 3%). It was also a bigger increase than any other CCG in England in 2015/16 or 2016/17.

A healthcare professional taking someone's blood pressure using a pump monitor.

Using the NICE guideline to reduce blood pressure in patients at high risk

Practices in Lambeth significantly reduced blood pressure in patients at high risk, as part of a CCG-wide project. They identified people with systolic blood pressure of 160 mmHg or more, diastolic blood pressure of 100 mmHg or more, or both. The CCG offered materials based on our guideline on hypertension, and ran a virtual clinic and pharmacist-led community hypertension clinic for complex cases.

For people with high systolic blood pressure, the mean reduction was 25 mmHg. This could reduce stroke risk by 60% and coronary heart disease risk by 45%.

For people with high diastolic blood pressure, the mean reduction was 17.9 mmHg.

An electronic blood pressure monitor sits on a table next to somebody's arm.