Foot ulceration in people with diabetes is an increasing problem which is costly to the NHS financially and to patients in terms of quality of life. Management is complex and involves a team approach to ensure the best results for patients.
As many as 16 million people in the UK are estimated to have hypertension, and around 7 million of these are undiagnosed. Of those diagnosed in England, one third are not receiving optimum management. Poor detection and management of hypertension places a significant burden on the NHS, and hypertension-related conditions cost an estimated £2 billion a year. We can change this by raising awareness of the consequences of hypertension, making it simpler to diagnose, and by supporting patients to manage their own health. The benefits of doing this are huge – just a 15% increase in the number of adults in England who have had their hypertension diagnosed would add 7,000 qualityadjusted life years and reduce health and social care costs by £120 m over ten years.
Obesity is estimated to be responsible for more than 30,000 deaths each year, reducing lifespan by an average of nine years. The links between obesity, diabetes and cardiovascular disease are well documented, but overweight and obesity also causes 6% of cancers in the UK. These figures have resulted in warnings that obesity is the new smoking when it comes to risks to health and longevity. So the problem is clear. The challenge is to put into action what works.
Cardiovascular disease (CVD) is the leading cause of death worldwide. Elevated blood pressure (BP) is the main global risk factor for premature morbidity and mortality, and the prevalence of hypertensive heart disease is not declining over time. Improved control of high BP is, therefore, fundamental to further prevention of CVD, and adoption of treatment guidelines can have a positive impact on BP-related outcomes.
The Public Health England (PHE) action plan for 2017-181 outlined the scale of the cardiovascular disease (CVD) issue we face here in the UK. Affecting around 7 million people, CVD remains a significant cause of disability and death. In England, we know that it is responsible for one in four premature deaths and over a quarter of all deaths, which not only affect the individual but also their families, and impact the wider community too. Healthcare costs associated with CVD are estimated at £8.96 billion and non-healthcare costs at about £4.04 billion. 2 A recent report discusses the evidence for the success of population-based CVD prevention programmes in reducing the burden of illness for individuals and society.
The NHS Health Check is a national programme offering a health check-up every five years to adults in England aged 40 to 74 without a pre-existing cardiovascular condition. One of the largest prevention programmes of its type in the world, the programme is designed to help prevent and detect early signs of heart disease, stroke, kidney disease, type 2 diabetes and dementia. 1 This article reviews the evidence that has accumulated since the programme was established.
Given that cardiovascular disease (CVD) is responsible for a quarter of all deaths in the UK and is the largest cause of premature mortality in deprived areas, the NHS Long Term Plan recognises that CVD is the single biggest area where the NHS can save lives over the next 10 years.
In the 70 years since the NHS was founded there have indeed been remarkable successes in reducing mortality from common conditions, an important example being deaths due to heart and circulatory disease. Yet the statistics show that there is more to be done to prevent the toll of premature death and years of disability associated with cardiovascular disease (CVD). For this reason, we welcome the continuing focus on CVD prevention as set out in this publication, produced with the support of Public Health England and NHS England.
This month’s Back to Basics feature is a useful optimal value pathway on cardiovascular disease prevention from NHS RightCare. The pathway shows a number of elements of an optimal CVD prevention pathway including the evidence base, clinical interventions, information on the risk conditions and potential opportunities for improvement.
This month’s Back to Basics focuses on the different drugs used in the management of hypertension. The wallchart provides a useful summary of the different antihypertensive drug classes and how they act to regulate blood pressure.