High blood pressure (hypertension) is the key risk factor globally for death and disability. In the UK it is the most common long-term health condition, affecting over 8 million adults (14%).

‘Hypertension Plus’ is a service that allows GPs and patients to share information about home blood pressure levels and treatment recommendations using home blood pressure monitors and their mobile telephones. It provides reminders for monitoring and alerts for action to both patients and health care professionals.

The service, developed based on work by the Nuffield Department of Primary Care Health Sciences, University of Oxford, has been­­ further developed by Omron Healthcare for roll-out and use across the globe.

The SHIP Study will evaluate how well this new service works and how best to use it in practice, and is split into two main branches: an evaluation of the service (service evaluation) and an examination of how it is being used in real life by GPs and patients (a qualitative study).

High blood pressure is the key risk factor globally for death and disability and is associated with many life-limiting and costly conditions to treat, including; stroke, heart disease, heart failure, and dementia.

However, we do know that effective use of blood pressure lowering medications can significantly reduce the risks and harms of such conditions.

Despite this, we also know that blood pressure medication is not always well managed by both patients and GPs, leading to harms that could have otherwise been avoided.

Members of the research team have previously shown that allowing patients to monitor their own blood pressure at home – rather than travelling for GP appointments, for example – and managing their own blood pressure medication (with guidance), can be an effective method of controlling high blood pressure. And, importantly, patients find it acceptable and value it for allowing them more autonomy in their own care.

This study builds on twenty years’ experience of self-monitoring/management of hypertension and will investigate and evaluate the implementation into primary care of a digital intervention developed specifically from this experience.      

Service Evaluation

The service evaluation will use anonymised routinely collected data (that is information recorded by practices and patients in their routine care), such as blood pressure and medication usage and will compare those using the system with those that do not use the system.

We will study:

• How many GP practices are using the system,
• How well patient’s blood pressure is controlled,
• The system effects on GP workload (number and length of appointments concerning blood pressure as well as the job roles of those individuals),
• how cost effective the system is, and
• how the system affects related issues, such as prescription of medications.

Qualitative Research­ Study

This will use a variety of methods to investigate How and Why the use of Hypertension-Plus may succeed or fail over the course of one year.

This will be done, for example, by collecting and analysing interviews with organisations and GP practices who are using or not using the system (e.g. Primary Care Networks or GP surgery leads), as well as eligible patients and caregivers using patient audio diary entries; and customer service data from Omron.

This work has been developed over the past 20 years, supported by patients and public from a range of settings which have included review of patient facing study documentation from a clear writing expert, and work with The British Heart Foundation, The Stroke Association and other PPI groups.

Our project All Investigators Group which meets regularly monitor progress and keep it on track includes PPI representation. We will also continue to work with our patient and public collaborators and a broad range of patients (and their carers) who have lived experience of blood pressure problems, to ensure our research remains relevant to the needs of all those in this group.

The findings from the service evaluation and qualitative study will provide evidence of the value of using the system in practice (in terms of time, cost and improvements in patient care). This will help CCGs and other policy makers in their decision to use the system. Our findings will also identify existing barriers or facilitators for successful implementation and perhaps patient groups that will particularly benefit from the system or require more support.