High Blood Pressure: policy context

Most policy in the NHS in Scotland refers to diseases and services. There is no specific policy on high blood pressure, but there is a strategy on coronary heart disease and stroke (see the Better Heart Disease and Stroke Care Action Plan, 2009). Its approach is supported by the NHS Quality Improvement Scotland (now Health Improvement Scotland) Clinical Standards for Heart Disease 2010.

There is specific guidance on the clinical management of high blood pressure in Scotland in the form of the Scottish Intercollegiate Guideline Network (SIGN) guideline 97 (2007) - Risk estimation and the prevention of cardiovascular disease and separate SIGN guidance recommends the use of antihypertensive medication for people with a previous stroke or transient ischaemic attack (TIA) regardless of blood pressure, unless contraindicated SIGN 108 Management of patients with stroke or TIA: Assessment, investigation, immediate management and secondary prevention 2008.

Guidance is also provided in the NICE clinical guidelines CG127 (2011) Hypertension: clinical management of primary hypertension in adults and its associated Hypertension: Evidence Update March 2013, in NICE public health guidance 25 Prevention of Cardiovascular Disease  and its associated Prevention of cardiovascular disease: Evidence update January 2014 and specifically for those with type 2 diabetes in the NICE clinical guidelines CG87 (2009) Type 2 Diabetes - newer agents (partial update of CG66) , for the management of chronic kidney disease in the NICE clinical guidelines CG73 (2008) Early identification and management of chronic kidney disease in adults in primary and secondary care and for the management of acute stroke in the NICE guidelines CG68 (2008) Diagnosis and initial management of acute stroke and transient ischaemic attack (TIA).

High Blood Pressure also features in the Quality and Outcome Framework for the new General Medical Services contract (see Quality and Outcomes Framework (QOF)) and the JBS 2: Joint British Societies' guidelines on the prevention of cardiovascular disease in clinical practice also covers those with elevated blood pressure. Revised Joint British Societies guidelines are in the final stages of development, for details see the JBS 3 website.