What we looked at and why

SHTG recommendation

In response to enquiry from the Scottish Government CVD Risk Factors Steering Group.

What were we asked to look at?

The Cardiovascular Disease (CVD) Risk Factors Steering Group, part of the Scottish Government’s Preventative and Proactive Care Programme, asked us to look at the evidence for HBPM or remote blood pressure monitoring (BPM) in people with suspected or confirmed hypertension. The outcomes requested included clinical effectiveness, healthcare appointments, safety, patient aspects and cost effectiveness. The terminology and definitions associated with the intervention (HBPM or remote BPM) varied across studies we reviewed. Throughout our review, we used the term HBPM, which includes ‘self-monitoring’ and remote BPM. Co-interventions alongside HBPM are described explicitly and clarified where necessary. The evidence we examined was inclusive of any supporting digital applications.

Why is this important?

Hypertension, or high BP, is a serious condition which if left untreated, can lead to complications such as kidney failure, heart failure, problems with sight, or vascular dementia. Hypertension is linked to over 50% of all strokes and heart attacks. The Scottish Health Survey estimated that during the years 2022 and 2023, 31% of adults (n not provided) in Scotland had been diagnosed with hypertension and 19% (n not provided) had untreated hypertension as described by the survey. It is unclear whether those who had untreated hypertension had been diagnosed. The prevalence of hypertension increases with age, with 69% of those aged 75 years and above having hypertension. Hypertension is the third most common reason for a visit to a General Practitioner (GP) in Scotland, equating to 1.2 million hypertension-related appointments each year. CVD is one of the main drivers of demand on unscheduled care services in Scotland. Hypertension is a modifiable risk factor for CVD associated disability. HBPM offers a way to facilitate the measurement of BP and the prevention, diagnosis, optimisation of treatment, and management of the condition.

What was our approach?

We produced an SHTG Recommendation based on a review of the evidence for HBPM or remote BPM in people with suspected or diagnosed hypertension, compared with routine care (no HBPM or remote BPM and telemonitoring, such as include face-to-face GP appointments). We also developed a de novo economic model to assess the cost and benefits of the Connect Me BP programme.

What next?

Our SHTG Recommendation will inform decision-making by the CVD Risk Factors Steering Group.