Hypertension Theme: Health and Wellbeing Status Background Information

High blood pressure (hypertension) is usually defined as having a sustained blood pressure of 140/90mmHg or above and is a major risk factor for developing a serious cardiovascular disease, such as a stroke or heart disease. High blood pressure is common, with 40% of adults in England having the condition and the number of people who have high blood pressure increasing with age.

Hypertension is a preventable cause of ill-health with all available evidence showing that lifestyle plays a significant role in regulating blood pressure. Risk factors for high blood pressure include: age; excessive alcohol consumption; poor diet; lack of exercise and obesity. High blood pressure can therefore be treated or prevented by making changes to your lifestyle whilst medicines are also available that can help lower blood pressure.

Data The prevalence data consist of the number of people on GP practice disease registers at the end of March 2009. This data was taken from the Quality Management and Analysis System (QMAS). QMAS is a national system which shows how well each practice is doing, measured against national Quality and Outcomes Framework achievement targets. Since this only includes people on GP practice registers it probably underestimates the actual number of people classified as hypertensive in the population. Prevalence refers to the number of cases recorded over a specified period of time (in this instance 2008/09).

Modelled prevalence estimates and projections are taken from the APHO and give the number of people (aged 16 and over) with hypertension.

Modelled and Recorded Prevalence

Figures from QOF for 2008-09 detail that 75,544 Cumbrian patients were included on the Hypertension register (i.e. have been diagnosed with hypertension). This accounts for 14.5% of the Cumbrian GP population compared to the England average of 13.1%. Modelling by the Association of Public Health Observatories (APHO) suggests that there should be over 66,000 additional patients with hypertension that do not currently appear on the GP registers in Cumbria (i.e. undiagnosed).

The percentage of people on GP practice hypertension registers was greatest in Copeland and Allerdale with a prevalence of 15.0% whilst Barrow-in-Furness had the lowest with 14.2% (Table 1). All district councils had a prevalence rate above the national average of 13.1%.

02 March 2010 1 Table 1 also shows the estimated 2007 prevalence of hypertension (diagnosed and undiagnosed) in Cumbria and by district council compared to the observed prevalence from the local QOF register. The data show that in Cumbria as a whole, 47% of people with hypertension in are not included on the QOF registers. This has possible implications with undiagnosed and unmanaged hypertension resulting in an increased risk of developing the serious health issues outlined previously. Highest levels of undiagnosed hypertension are in seen in Copeland and Eden (51%) and lowest levels are in Barrow-in-Furness (36%).

Table 1: Recorded and expected prevalence of hypertension by district council (QMAS and APHO)

Recorded (QMAS Modelled (APHO 2007) Difference 2008/09) Number on Prevalence Number Prevalence Number Percentag GP e practice Undiagnos disease ed register Allerdale 14,933 14.9% 27,058 34.8% 12,125 44.8%

Barrow-in- 11,954 14.2% 19,063 32.8% 7,109 37.3% Furness Carlisle 15,648 14.4% 28,494 33.2% 12,846 45.1%

Copeland 9,425 14.9% 19,232 33.3% 9,807 51.0%

Eden 7,428 14.3% 15,164 35.0% 7,736 51.0%

South Lakeland 15,986 14.6% 29,740 33.8% 13,754 46.2%

Cumbria PCT 75,544 14.5% 142,389 34.6% 66,845 46.9%

Projections

The number of people in Cumbria who are predicted to have hypertension from 2008 to 2020 is shown in Figure 1. The number aged 16 and over is projected to rise, increasing from 143,976 in 2008, to 169,325 in 2020: an increase of 17.6%. With the exception of the 16-44 age group, all age groups are expected to experience an increase in numbers although the greatest percentage increase is predicted for people aged 75 and over (34.1% increase).

02 March 2010 2 Figure 1: 2008-20: People aged 16 and over predicted to have hypertension

Cumbria: People aged 16 years and over predicted to have hypertension, by age, projected to 2020 (APHO)

180,000

160,000

140,000

120,000

r 100,000 e b m u

N 80,000

60,000

40,000

20,000

0 2008 2010 2015 2020

16-44 45-64 65-74 75+ Total population aged 16 and over Projections by district council also show an increase in those aged 16 and over expected to have hypertension (Figure 2). The greatest numbers are predicted to be in South Lakeland but the largest percentage increase is expected for Eden (23.1%).

Figure 2: 2008-20: People aged 16 and over predicted to have hypertension by district council

People aged 16 years and over predicted to have hypertension, projected to 2020 by district council (APHO)

40,000

35,000

30,000

25,000 r e b

m 20,000 u N

15,000

10,000

5,000

0 2008 2010 2015 2020

Allerdale Barrow-in-Furness Carlisle Copeland Eden South Lakeland

Inequalities in Cumbria

According to data from the primary care registers, there appears to be no relationship between hypertension prevalence and deprivation with prevalence being lowest in the most and least deprived quintiles and highest in quintiles 3 and 4 (Figure 3).

Figure 3: Hypertension prevalence by deprivation quintile

02 March 2010 3 2008-09 Crude Prevalence Rate for Hypertention by Deprivation Quintile of GP Prcatice in Cumbria

15

14.8 Cumbria average = 14.5%

14.6

14.4

14.2 %

e c n e

l 14

a 14.9 v 14.8 e r P 13.8 14.5 14.5

13.6 14.2

13.4

13.2

13 1 - most deprived 2 3 4 5 - least deprived GP Practice Deprivation Quintile

02 March 2010 4