Reducing blood pressure can take years off your ‘Heart Age’A new project will equip nurses and pharmacists to help patients reduce their risk of heart disease, stroke and dementia
Around one in four adults in Europe has high blood pressure. The condition is often undetected but significantly increases the risk of cardiovascular disease and vascular dementia. The chances of having high blood pressure, also known as hypertension, increases with age. As health professionals, policymakers and citizens are increasingly focused on healthy ageing, controlling blood pressure has moved centre stage.
Behavioural factors play a major role in blood pressure. From diet and exercise to consistently taking prescribed medication, the power to curb hypertension lies in the hands of those at risk. The challenge is to inspire people to take action.
A new research project in England and Ireland will explore how health professionals can engage patients in making the changes they need to stay healthy. This specific project is part of a broader programme called Project chAnGE, supported by Upjohn, a Pfizer division, launched under the European Innovation Partnership Action on Health Ageing (EIP on AHA). Project chAnGE aims to identify gaps in Europe in relation to healthy ageing in people with non-communicable diseases, and support the necessary changes in clinical practice.
‘A silent gift’
The initiative will be led by Christine Hancock, the Founder of C3 Collaborating for Health, a UK-based charity. As a clinician, economist and health service leader, as well as former CEO of the Royal College of Nursing for 12 years and president of the International Council of Nurses, Christine has a wealth of insights into what shapes outcomes for people with chronic conditions. The big one, she believes, is to encourage physical activity.
‘It’s a silent gift we can give to people of all ages,’ Christine says. ‘Physical activity can make a real difference to people’s health. For older people, it’s even more important – any activity you do can make a positive impact.’ By increasing exercise and staying active, people can lower their blood pressure and protect themselves from ill-health. ‘Hypertension is the secret threat,’ she adds. ‘It is often unrecognised and can have a major impact on health outcomes.’
This is echoed by Michaela Nuttall, a cardiovascular nurse specialist at C3, and an active member of the British & Irish Hypertension Society. She believes healthcare professionals underestimate the impact of blood pressure and that there are shortcomings in how hypertension is detected and managed.‘Around 25% of the adult population has high blood pressure and half of those are undetected,’ Michaela explains. ‘Of those who have been diagnosed, only half are achieving their target – there is plenty of room for improvement.’
As populations age, the urgency of addressing blood pressure grows. Controlling hypertension not only cuts death rates from cardiovascular disease, it also reduces illnesses that can have a devastating effect on people’s lives – including dementia and stroke. In short, controlled blood pressure translates into healthier ageing and better quality of life.
Making a change
However, changing behaviour is tricky; sustaining change is harder still. Whether it’s better diet, more exercise or adherence to medicines, people at risk of cardiovascular disease need to make changes that stick. This is where shared decision-making comes in. Rather than simply ‘following doctor’s orders’, there is a growing appreciation of the need to engage patients as co-decision makers. Not only can this help to identify feasible lifestyle changes and design tailored tips for how to achieve them, it encourages patients to take ownership of their new regime.
Mark Cobain, an expert in health psychology and risk communication at Younger Lives, was an author on the most recent Framingham Risk Score and lectures on preventive Cardiology at Imperial College. His expertise has helped Younger Lives to develop tools that test patients’ Heart Age and offer positive actions to ‘take years off’ it.
Heart Age is calculated using data on age, height, weight, gender and ethnicity, along with a handful of key health and lifestyle indicators – such as blood pressure, cholesterol, diabetes and smoking status. The goal is to help individuals understand their risk of heart disease, and what they can do about it, in a way both emotionally impactful and easy to understand. ‘In the past, health professionals have usually talked to their patients about their percentage risk of developing heart disease over ten years. This is a complex concept, that can be hard to understand, and can even give people a false sense of security with high risk percentages of 15%+ not actually sounding too bad in layman’s terms!’ explains Mark.
Heart Age works differently, as it explains your risk in terms of what we would expect for your age. “For instance, if a 50 year old man had high blood pressure and raised cholesterol, that could give him a risk score of 15%, which you would normally associate with a healthy 65 year old – and therefore that man’s heart age would be 65 - 15 years older than his actual age.’ says Mark. ‘This way of framing risk, in the form of an age, evokes an strong emotional response, and motivation to act, because nobody wants to think of their heart as being older than their age in years. Pairing this result with practical actions that people can do to ‘take years off’ is a powerful combination and has been clinically proven to improve health.’
Pharmacists and nurses are well-placed to talk with at-risk populations about their Heart Age because they have regular contact with key target groups, including older people and those being treated for chronic conditions. They are also accessible and, in many cases, have additional information about what might be practical for their patients in terms of physical activity.
In collaboration with charities in the UK and Ireland, the research team will begin the project by engaging with patients to understand the kinds of messages that are most likely to resonate. From there, they will work with nurses and pharmacists to determine their training needs and how this could most effectively be met. A training programme will then be piloted to support communication and framing of hypertension risk and the benefits of intervention.
Digital Heart Age tools will also allow patients to click on actions they are committed to taking, including pledges to become more physically active, improve their diet, take medication or review their prescription with a health professional. This allows the researchers to review anonymised data on how users respond to information about their Heart Age and potential solutions to reduce it.
Insights & impact
Insights from the project have the potential to shape clinical practice across Europe and beyond. As well as determining the potential impact of shared decision-making in patient behaviour, it will help fine-tune the Heart Age tool to ensure it fits well with pharmacist and nursing workflows.
Above all, it will contribute to a wider shift towards preventative interventions that spare individuals and health systems the burden of hypertension-related illnesses. ‘There is a lot of focus on the role of doctors in prevention,’ says Mark. ‘But we also need to think more about nurses and pharmacists – they can make a tremendous difference.’
As a project driven by a charity and two SMEs, the researchers see potential for swiftly translating their results into practice. ‘We see the value of prevention and want to see evidence-based action implemented in the real world,’ says Michaela. ‘Our project is a little different to a classic academic study – but that’s what makes it so exciting.’