World Hypertension Month

– in the Scottish Parliament at on 23 May 2017.

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Photo of Linda Fabiani Linda Fabiani Scottish National Party

The final item of business is a members’ business debate on motion S5M-05136, in the name of Maree Todd, on May 2017—world hypertension month. The debate will be concluded without any question being put.

Motion debated,

That the Parliament notes that May 2017 marks World Hypertension Month; understands that this awareness month will highlight this silent condition, which is a preventable cause of stroke and heart disease, and provide information regarding its prevention, detection and treatment; notes that it is estimated to cause around nine million deaths globally each year; understands that 30% of adults in Scotland have high blood pressure, half of whom are not receiving treatment, and that 70,860 people in the Highlands and Islands region are living with the condition, and acknowledges and welcomes the work of Professor Rhian Touyz, of the British Heart Foundation Centre of Research Excellence at the University of Glasgow, which aims to understand the causes of hypertension.

Photo of Maree Todd Maree Todd Scottish National Party

I remind those in the chamber that I am a pharmacist who is registered with the General Pharmaceutical Council. I am also a member of the Health and Sport Committee and a co-convener of the cross-party group on heart disease and stroke.

It was because of my role on the cross-party group that I was keen to bring a debate about hypertension to the chamber, to highlight not only the condition but the great work of Professor Rhian Touyz and the British Heart Foundation in researching and tackling what is known as the silent killer.

As the motion states,

“30% of adults in Scotland have high blood pressure”,

and more than 70,000 people in the Highlands and Islands—the area that I represent—live with the condition. It is very common indeed.

Why do we need to raise awareness about the condition? Hypertension is a crucial risk factor for cardiovascular disease, which causes more than a quarter of all deaths in Scotland—that is nearly 16,000 deaths a year. In particular, hypertension increases the risk of heart attack and stroke. I will say a bit more about that later.

What is hypertension? Hypertension, or high blood pressure, is blood pressure that is consistently higher than the recommended level. A person has hypertension if their readings are consistently equal to or more than 140/90 millimetres of mercury and the target level is a wee bit lower for those with diabetes.

Hypertension can damage arteries, put extra strain on the heart muscle and increase the risk of heart attack and stroke. It contributes to more than a fifth of all heart attacks and half of all strokes and increases the risk of conditions such as renal failure and dementia.

Hypertension can be prevented. Even a small decrease in blood pressure—say, 2/4 millimetres of mercury—at the population level could significantly reduce the prevalence of stroke and heart disease. Therefore, increasing public awareness is crucial, as is access to early detection and appropriate treatment.

I will tell members about the rule of halves and how it applies to high blood pressure. Only half the patients with high blood pressure in a population have been diagnosed; only half the patients in whom high blood pressure has been detected have been treated; and only half the patients who have been treated have been adequately treated so that their blood pressure has returned to a normal level.

One of the biggest problems in controlling high blood pressure is what we call compliance, or concordance, with treatment. Here is another half: as a pharmacist, I know well that only about half the people who are prescribed medication take it as the prescriber intended them to. Given that background, I know that my community and primary care clinical pharmacy colleagues, with their expertise in pharmaceutical care, will be able to improve outcomes for folk with hypertension.

A particular challenge with high blood pressure is that folk do not feel ill. That is why it is called the silent killer—a person does not know that they have it until they get their blood pressure checked, and they feel the effect of it only after some damage has been caused to target organs.

In my experience, most people would rather not take medication, especially if it causes side effects. It is pretty hard for a person to persevere with medication that can temporarily make them feel lousy, when they felt perfectly well before they started it. Another problem is that people stop or reduce medication when their blood pressure falls to normal levels, but the condition does not go away.

Therefore, although effective and cost-effective drugs are available, target blood pressure levels are often not reached. I am thankful that in Scotland we have free prescriptions. Although there might be many barriers to taking medication as prescribed, cost is not one of them.

I do not want to paint too bleak a picture, because we have made incredible progress in reducing cardiovascular morbidity and mortality rates in Scotland. However, given that so many illnesses and early deaths are preventable, we want to do more.

I highlight the impact of high blood pressure on stroke—it contributes to half of all strokes, as members will recall me saying. Stroke is the most common cause of severe physical disability among adults, and half of stroke survivors have a disability. About 15,000 people in Scotland have a stroke each year, and up to 80 per cent of strokes could be prevented. Preventing and correctly treating hypertension is far less costly and much safer for patients than the interventions that might be needed when it has not been treated effectively and has led to damage.

The cause of most hypertension is unknown. In a very small number of people, there is a specific cause—for example, kidney disease—but mostly we do not know why someone gets it. Even though we do not know the cause, we know that maintaining a healthy weight, getting regular physical activity, cutting down alcohol intake, stopping smoking and reducing salt intake can help to maintain a healthy blood pressure.

The recommended daily allowance for salt intake is 6g, but about two thirds of us in Scotland eat more than that. We politicians need to make it easy for people to do the right thing. At the moment, energy-dense, high-salt foods are easily available, affordable and widely accepted, which makes an unhealthy lifestyle the default option. It is cheap and easy to eat badly in Scotland. If only it could be cheap and easy to eat more fruit and veg. As I have said before, we need, for many reasons, a programme of action that has at its core brave and bold fiscal, regulatory and perhaps legislative measures to change our food environment.

I will highlight some of the important research that the British Heart Foundation does and mention the work of Professor Rhian Touyz, who works at the institute of cardiovascular and medical sciences in the University of Glasgow and specialises in hypertension. Here in Scotland, she and her team are unlocking some of the secrets of the condition and discovering some of the molecular mechanisms, such as the enzyme NOX5—a protein that is involved in the inflammatory process and which damages the blood vessels, narrowing them and making blood pressure rise. Professor Touyz’s research will increase our understanding and potentially enable the development of new therapies.

World hypertension day was on 17 May, and the International Society of Hypertension is running May measure month. As part of the programme, the British Heart Foundation has been encouraging people to know their numbers by offering free blood pressure and type 2 diabetes tests at 375 Tesco stores across the United Kingdom. Blood pressure checks are also available in Superdrug. There is no excuse for people not to know their numbers this month.

I remind everyone that this common condition can be diagnosed with a simple test, and it is easy to treat. I encourage everyone to take the opportunity this month to know their numbers.

Photo of Donald Cameron Donald Cameron Conservative

I thank Maree Todd for lodging the motion and for setting out the definition of hypertension and the difficulty in establishing its causes. She spoke about preventative measures. As a fellow member of the Health and Sport Committee, she knows well that we have, during this session of Parliament, touched on that subject on many occasions in committee and in the chamber. It is clear that many conditions that are prevalent in Scotland are largely preventable, through a combination of improving diet, increasing physical activity and reducing stress. We know, however, that that is easier said than done.

The motion notes that world hypertension month sets out to raise awareness of the condition, which affects about 30 per cent of adults in Scotland. Almost a third of adults is a very high proportion to suffer from one condition. The motion also highlights the need to understand and to improve knowledge of the causes of hypertension, and highlights the need for early intervention. I will discuss those three areas individually.

I begin with the need to raise awareness of the condition and the importance of people simply seeing their general practitioner regularly, even if it is just for a check-up. As Chest Heart & Stroke Scotland notes, it is difficult to know whether one has high blood pressure because there are rarely symptoms or visible afflictions—hence the importance of a visit to the GP or local pharmacy, where a free blood-pressure check can be provided. People can also buy digital blood-pressure monitors to take regular tests at home. Given the relative affordability of such kits, that is a viable option for many people, although clearly not everyone. I highlight in particular the option of using pharmacies, as we try to move care further into the community and enhance the role of pharmacists. As people begin to use fewer acute services and more community-based services, it is vital that we all do as much as possible to promote the services that are offered in and outwith general practices, so that we are able to strike the right balance.

The motion mentions the need to understand the causes of hypertension. We know that preventative options are fairly limited in some cases—cases involving genetic factors or old age, for example. However, a variety of causes can be dealt with through lifestyle changes. A third of adults in Scotland are obese and 37 per cent of people do not do the recommended level of physical activity. Those issues can lead to high blood pressure, which can then exacerbate, or result in, a variety of conditions that are all too common in Scotland. Hypertension can lead to stroke, for example, from which there are about 26,000 hospital visits and 4,300 deaths each year. Heart attacks are another end result, from which there are 25,000 hospital visits every year.

Those and other conditions place a heavy strain on the NHS, so it is incumbent upon us all to identify solutions so that hypertension can be reduced and we can tackle the resulting conditions. Actions speak louder than words, and I am sure that Brian Whittle will tell us about his ideas for a healthy lifestyle strategy. He has already presented a document—which is by no means finalised or partisan—to kick-start a much-needed debate on early intervention and prevention.

I close by noting that we need more debates on issues such as world hypertension month; it is important that we raise awareness of specific conditions. Fundamentally, it is vital that we continue to debate and discuss the bigger picture of the need for early interventions and for policies that can achieve the ultimate aim, which is to cure Scotland of the many ills that continue to burden our nation.

Photo of Emma Harper Emma Harper Scottish National Party

I thank my colleague Maree Todd for securing the debate. As the motion says, May is hypertension awareness month, and world hypertension day is 17 May. We are having the debate today to raise awareness of hypertension, which is more commonly referred to as high blood pressure.

I support Maree Todd’s motion and remind Parliament of my interest as a non-practising nurse and member of the cross-party group on heart disease and stroke.

High blood pressure rarely has noticeable symptoms. If it is untreated, it increases the risk of more serious problems—cardiovascular problems such as heart attacks, and cerebral vascular events or strokes. The only way to find out if one’s blood pressure is high is to have it checked regularly. Health professionals—doctors, nurses or healthcare support workers—can check people’s blood pressure easily while assessing other vital signs including pulse, respiration rate and temperature. Many pharmacies can check blood pressure, and health roadshows encourage public engagement and offer people screening to find out whether their blood pressure is within normal limits.

There are various causes of high blood pressure. Being overweight can be a contributing factor. Too much dietary salt—as has been mentioned—alcohol and caffeine increase the risk of high blood pressure, as do smoking and lack of exercise. Even lack of sleep can be a contributing factor. It looks as though I may have five of those seven risk factors, although I will not tell Parliament which ones.

Once high blood pressure has been diagnosed, treatment involves pharmacological and non-pharmacological approaches. It is likely that one of the first approaches will be encouragement of lifestyle changes and help to achieve them in order to address factors such as smoking and diet.

Some people with high blood pressure may need to take one or more medicines to stop their blood pressure from getting too high, which requires their seeing the GP or advanced nurse practitioner for monitoring of the effects of prescribed medications. Studies show that many people do not take their antihypertensive medication regularly or at all. People must not omit their medications. The health consequences of prolonged high blood pressure can be catastrophic, including cardiovascular problems such as angina and heart attack, which require invasive procedures such as stent placement or coronary artery bypass.

The tiny wee blood vessels in the eyes can be damaged by hypertension, which can lead to retinal disease that can cause blindness. Eye tests are free in Scotland in any optometrist that provides NHS services. That helps with early screening, direct referral and faster access to treatment, and reduces the burden on GPs’ time.

The tiny wee blood vessels in the kidneys do not cope well with raised blood pressure, either. It can result in the kidneys’ ability efficiently to dialyse—or filter—waste products being compromised. Kidney damage leads to chronic kidney problems and electrolyte imbalance, which contribute to further health problems and potentially lead to lifelong dialysis.

One of the most high-profile consequences of high blood pressure is stroke. Increased public awareness of that risk is very welcome. Fantastic public information campaigns such as “STROKE—ACT F.A.S.T.” have been very successful at highlighting symptoms and saving lives. The FAST acronym is useful and is worth spelling out. “F” stands for “face”. Has it fallen on one side? “A” stands for “arms”. Can the person raise them? “S” is for “speech”. Is it slurred? “T” is for “time”. Anyone noticing any of those signs should call 999 immediately. The FAST acronym means that stroke can be recognised and dealt with quickly, which means that patients can be sent to dedicated stroke centres instead of waiting for assessment in a non-specialist place. I pay tribute to the four stroke liaison nurses in NHS Dumfries and Galloway—especially Christine Cartner, because I trained with her more than 30 years ago.

The message is that hypertension can be detected, checked, treated and controlled. I urge everyone to avoid potentially more complex health problems by having their blood pressure checked regularly, by making lifestyle changes where necessary and by not omitting to take their meds.

Photo of Anas Sarwar Anas Sarwar Labour

My thoughts and, I am sure, the thoughts of everyone in the chamber continue to be with our friends in Manchester, in particular as the tragic stories continue to be revealed and the victims are named.

Like Maree Todd, I want to record our thanks to all our amazing NHS staff—our first responders, our nurses, our pharmacists, our GPs or any of the rest who care for our fellow citizens all year round.

I thank Maree Todd for bringing forward the debate. What I like best about this kind of debate is that it gives us the opportunity do some research on medical conditions that we might have, to articulate our thoughts and opinions on those conditions in the chamber and, I hope, to raise awareness of important issues and encourage our fellow citizens to access treatment and to contact healthcare professionals to get proper diagnoses.

I do not think that Emma Harper is alone in having many of the hypertension risk factors. The vast majority of members, myself included, probably have a higher rates of hypertension—high blood pressure—than the average person. I am sure that our party whips have nothing to do with that.

Photo of Anas Sarwar Anas Sarwar Labour

My whip, who is sitting next to me, says, “Hear, hear.”

I thank Professor Rhian Touyz, whom Maree Todd mentioned, and the British Heart Foundation, which does a stellar job of bringing such matters to Parliament and of lobbying all parties on the important issues that affect the heart. Professor Touyz, who is a native of Canada, is based at the University of Glasgow, where she leads the cardiovascular research centre. Because of the BHF’s generous support of a combined grant of £2.75 million, she is able to do fantastic work, which Maree Todd set out, on the NOX5 enzyme and treatment and prevention of hypertension. That work could be a leading light right around the world. I record our thanks to Professor Touyz and the British Heart Foundation.

We have heard about the risks of high blood pressure and the conditions that it can lead to, which include heart disease, heart attacks, strokes, heart failure, kidney disease and so many others. We need to get the public health arguments across to the wider public. Risk factors include a family history of high blood pressure—I know that high blood pressure has regularly occurred in my household. An individual’s ethnicity can lead to a higher chance of having high blood pressure, as can a high amount of salt in one’s food, lack of exercise, being overweight or obese, drinking large amounts of alcohol, smoking and long-term sleep deprivation.

I suppose that we need to make the plea to people across Scotland that they should, first, recognise the symptoms. Secondly, they should access their health centres, whether it is their general practice or pharmacy, and have their blood pressure checked. They should look at their lifestyle, including diet, salt intake, how active they are, how much alcohol they consume, whether they smoke, caffeine intake, and whether they are getting the right amount of sleep. I promise and resolve to take more interest in all those things from this day on.

I thank again Maree Todd, Professor Touyz for her hard work, and the British Heart Foundation. Above all others, I thank my wife for keeping my blood pressure low.

The Deputy Presiding Officer:

I would be interested in her perspective on that.

Photo of Stewart Stevenson Stewart Stevenson Scottish National Party

Like other members, I thank Maree Todd for the opportunity to discuss something that is probably of interest to every one of us, with regard either to ourselves individually or to a family member.

I am not a regular reader of

Hypertension News

, but in the February 2017 edition I read about the objective of screening the blood pressure of 25 million people in May. I advise the chamber that I have made my little contribution to that, with the very helpful co-operation of my MSP colleague Emma Harper. Earlier today she had her sphygmomanometer and her stethoscope at the ready, and she took my blood pressure. It was not good news, but I had just come up the stairs and had not yet sat down and done my calming down. My blood pressure was 158 over 70, which is okay on the diastolic and a wee bit high on the systolic, and a wee bit higher than the previous time that I had it checked, when it was 130 over 75, which is kind of where I would like to be. However, I am going to go away and think about this salt business. I might even give up drinking for a couple of days. There are things that each of us can do.

There are a lot of quite interesting articles in

Hypertension News

. For example, there was an article about a slim and quite fit 54-year-old German lady whose systolic blood pressure is regularly over 300 and whose diastolic blood pressure is in the 170 to 180 range. She is quite healthy, but the drugs have stopped working for her. That is one illustration among many that each hypertensive person is likely to be individual and to require individual attention.

Hypertension News has also talked about a lot of work that has been done to identify DNA triggers that might create a predisposition to hypertension, or that one might address by resetting the DNA. It is fair to say that that has had almost no success whatsoever. It has been suggested that only 1 millimetre of mercury of blood pressure, which is but nothing—it is beyond clinical measurement accuracy—is attributable to DNA. Therefore, we do not know why hypertension happens, which is quite worrying in light of the number of people that it affects. We should continue to support the efforts of the British Heart Foundation and others to research conditions that adversely affect the heart. I know from the reading that I have done, at least today, that we know much less than I thought that we knew, and that is a bit concerning.

My hobby is family research. I have read more than 2,000 death certificates in my family tree, and am relatively pleased that dying from heart failure has not been a major cause of death in my family, although strokes have been quite common in it. I will go away and have a think about that.

As a private pilot, I have an annual medical, which includes testing my blood pressure, testing my urine to see whether I am diabetic, testing my hearing and eyesight, and an electrocardiogram test. In nearly 30 years, I have had only a single ectopic heartbeat in my ECG, which is good news, but there has been a steady growth in my blood pressure. That will not be unusual.

I am going to think about my diet—maybe salt in particular. The association of diet and hypertension is quite well known, and it is relatively well known that the Mediterranean diet is not associated with hypertension. The really bad news this week is that there is an olive oil shortage because of weather conditions. I encourage colleagues to use Scottish extra virgin rapeseed oil, which is a good substitute for olive oil. People can get it in my constituency in the north-east of Scotland. Do not worry: we have the solution in the north-east, even if the Italians are letting the side down by not producing enough olive oil.

The subject is fascinating, and I am sure that it will run. I am interested in hearing what Mr Whittle in particular is going to say, because I know that he is very interested in it.

Photo of Brian Whittle Brian Whittle Conservative

I, too, will be interested in what Mr Whittle has to say, because he has not written down a speech, and he is going to wing it.

I thank Maree Todd for bringing the subject, which I am extremely interested in, to the chamber. Hypertension month is pertinent to members, because the past month has probably raised our blood pressure figures more than the average, as has been said.

The causes of high blood pressure have been mentioned. It is really about the heart having to work much harder to push blood round the system, which is, of course, dangerous, because that contributes to the hardening of the arteries, strokes, kidney disease and the development of heart failure, as has been stated previously. The cause that I am really interested in is age. I wonder what that means as I make my journey through my 50s.

Photo of Brian Whittle Brian Whittle Conservative

I know. I am buoyed by the fact that Mr Stevenson is still with us.

My family has a history of high blood pressure.

It is interesting that people who are of African or Caribbean origin have a higher incidence of hypertension.

I turn to the real meat of the issue. The risk factors include high amounts of salt in food, as Stewart Stevenson mentioned; lack of exercise, which I will say a lot more about; being overweight and obese; regularly drinking large amounts of alcohol; smoking; and sleep deprivation. Prevention measures can include a healthy diet; limiting alcohol intake for at least two days a week, as Mr Stevenson said; losing weight; cutting down on caffeine, which is one of my big problems; getting active; and stopping smoking. Lifestyle modification really helps in addressing hypertension.

It is also important that people have a fallback position when they feel stressed. We are probably all aware of stress, especially today. My fallback position has always been to pull my kit on and go for a trot round the woods, preferably with my headphones on and some nice soothing music such as AC/DC. Plugging in my guitar and smashing out some AC/DC is really helpful too.

However, if I want to put my thoughts in order and think the problem through, I tend not to take my music with me when I run. I am trying to do that more now than I used to, especially for speaking in the chamber. I put my thoughts in order, but unfortunately my memory is not very good so I immediately forget everything by the time I go back into the house.

When I feel stress or a bit of pressure, I have a fallback position, which is important. I often wonder what happens to those people who do not have a fallback position. That allows the tension to build, as Donald Cameron described. That is where I focus most of my time in the chamber. Earlier this year, I tried to produce a document on healthy living. It was very apolitical—apart from the front cover, which said “Conservatives”, it did not mention politics. I wanted to look at how we make fresh fruit and vegetables more widely available across all demographics, as has been mentioned, and at how we encourage people to eat them.

Physical education is obviously of huge interest to me. It is about giving people tools for life so that they understand what physical activity does for their quality of life. We should certainly be looking at an educational intervention in that regard. As the Royal College of Physicians of Edinburgh states, physical activity should be embedded in

“primary care, secondary care, social care and health education as well as in the health and social care workforce and workplace.”

The primary objective of food procurement policy should be to ensure that meals are of the highest nutritional value. In Scotland, we have an issue with our health, and I am really keen on the preventative agenda.

I thank Maree Todd for bringing the debate to the chamber. I will stop there, Presiding Officer, because I could go on for a long time.

The Deputy Presiding Officer:

I was beginning to realise that, Mr Whittle.

Photo of David Torrance David Torrance Scottish National Party

I played my part in addressing the issue of hypertension earlier this month, when I was given a monitor to wear for a day. I handed it in the next day, and the doctor phoned me and said, “You peaked at 240/190”. I said, “Oh, right”. He asked me where I had been at half past 7 the night before; I said that I was at my branch meeting. There is a clue: members should not go to their branch meetings and their blood pressure will be all right.

I too thank Maree Todd for bringing the debate to the chamber in recognition of world hypertension month, which raises awareness of those who are suffering from stroke and heart conditions. It is crucial that we recognise not only those who are affected by high blood pressure, but those who remain undiagnosed with a silent condition.

The International Society of Hypertension presents, through its blood pressure awareness campaign—May measurement month—the ambitious goal of screening 25 million people who have not had their blood pressure measured for more than a year. That involves screening an average of 100 people on 100 sites in 100 countries every day throughout the month of May. It is an ambitious yet achievable goal and, by working together, we can make a difference by tackling the biggest single contributor to global death.

Sixteen million people in the United Kingdom have high blood pressure and one third of them do not know they have it, as high blood pressure rarely has any symptoms. Those people are also three times more likely to develop heart disease and stroke.

High blood pressure is entirely preventable and one of the most preventable conditions, but it still remains one of the leading causes of death in the UK. We face complex challenges to prevent and control hypertension globally and nationally, and I hope that the data collected during world hypertension month can be used to support research on a national, regional and global level.

There is only one way to identify blood pressure, which is by having a GP or other health professional measure it. That is why we need to educate people and increase awareness.

Hypertension risk varies with income. Those of lower socioeconomic status are much more likely to develop heart conditions than those who are wealthier and generally better educated. The risk persists even with long-term progress in addressing the main risk factors such as smoking and high cholesterol. That is why low socioeconomic status needs to be regarded as a heart disease risk factor in itself by the medical community as well as the political community, as the effects are cumulative.

Among women especially, it has been proven that levels of high blood pressure increase as income decreases. According to the British Heart Foundation, women are less likely to seek medical attention and treatment despite the warning signs. The risk of heart disease and menopause are correlated, and risk continues to increase with age. Women’s hormones might provide some protection from heart disease, but the risk rises post menopause.

It is crucial for women to recognise symptoms. Heart disease kills more than twice as many women as breast cancer every year, but society still perceives it as a “man’s disease”. The women in hypertension research network was

“established to encourage, support and inspire women in science and medicine in the field of hypertension and related” heart conditions, and it creates avenues for women to communicate, collaborate and educate.

In 2016 in Scotland, 30 per cent of those tested had high blood pressure. The number is higher in Fife, where 39 per cent of those tested have high blood pressure. Keep well clinics—a Scotland-wide programme—seek to reduce the risk of ill health, and there are several clinics across Fife where community nurses can measure blood pressure.

Despite the tremendous services provided by the NHS, heart disease can place a massive emotional burden on people and create serious financial stress. In Scotland, Chest Heart and Stroke Scotland and Citizens Advice Scotland have appointed three benefits advisers to give advice and information about social security benefits for people who need assistance.

In conclusion, I applaud the efforts by those involved in world hypertension month to improve the population’s overall health. We need to prevent people from developing high blood pressure in the first place by encouraging better diet and exercise, and by reducing stress. I hope that the initiative brings together communities, healthcare professionals, health systems, non-profit organisations, charities, and private sector partners to improve care and empower the Scottish population to make heart-healthy choices.

Photo of Colin Smyth Colin Smyth Labour

I echo other members in thanking Maree Todd for lodging the motion and giving us the opportunity to play our part in raising awareness of world hypertension month and stressing the dangers of that silent killer.

I also thank the British Heart Foundation for its excellent briefing, which I found very helpful when I was preparing for the debate, and for all the work that it does to lead the fight against heart disease. I echo the comments of others in paying tribute to our healthcare workforce, today of all days.

Hypertension, or high blood pressure as it is more commonly known, affects almost 30 per cent of the adult population in Scotland. It is a crucial risk factor in cardiovascular disease, which causes more than a quarter of the deaths that take place in Scotland each year. In fact, it is estimated that 670,000 people live with cardiovascular disease in Scotland, at a cost to our health service of £800 million a year.

As well as being a major cause of cardiovascular disease, hypertension also has a significant impact in relation to the risk of developing other serious conditions. It contributes to more than one fifth of all heart attacks and half of all strokes, and increases the risk of developing conditions such as renal failure and dementia.

However, despite the huge risks that are associated with hypertension, around 7 million people across the UK live with undiagnosed high blood pressure. Of the 30 per cent of adults in Scotland who live with hypertension, half receive no treatment. Of those who are diagnosed, one in six is not treated effectively enough to reduce their blood pressure to target levels. It is therefore not surprising that the British Heart Foundation recommends that everyone who is over 40 should have their blood pressure checked—looking around, I think that that probably means most of us in the chamber.

There have been Government-backed campaigns to encourage people to have their blood pressure checked, but many health professionals rightly argue that those campaigns often succeed in encouraging mainly the worried well to have checks, rather than those who are most at risk of developing cardiovascular disease, particularly those who live in the most deprived communities and are victims of the inverse care law.

Now, more than ever, we need creative solutions to what is a significant health challenge to ensure that those who are most at risk receive the diagnosis and treatment that they need. Our GPs will remain the first port of call for many people seeking healthcare and health advice but we all know that our GPs, in almost every area of the country, are stretched beyond capacity. We need not only to build capacity within our GP surgeries and make sure that we tackle the chronic shortage of doctors but to consider other services to ensure that everyone is made aware of the importance of checking their own blood pressure or having their blood pressure checked.

Extending blood pressure checks from GP surgeries into more community pharmacies and community outreach services could go some way towards reaching those who are most at risk of hypertension. When the minister sums up, I ask her to say whether the Government is encouraging that approach and what other measures the Government intends to take to overcome the current barriers to the diagnosis of hypertension.

Preventing and correctly treating hypertension is of course far less costly than the interventions that may be needed when hypertension is not diagnosed or treated effectively. Maintaining a healthy weight, getting regular physical exercise, cutting down on alcohol intake and reducing salt in our diet can all go some way towards maintaining a healthy blood pressure, but we know—as Donald Cameron highlighted—that two thirds of adults in Scotland are now overweight, with more than a fifth of children in Scotland at risk of being overweight or obese by the time they reach school. Determined measures are therefore needed.

I once again urge the Government to include in the new obesity strategy that is to be published later this year firm action on unhealthy supermarket promotions and restrictions on multibuy discounts on unhealthy food so that the healthy choice becomes a cheaper option for Scotland’s families.

Reducing our calorie intake alone is not enough to mitigate the risk of hypertension. As Stewart Stevenson and Brian Whittle both highlighted, two thirds of adults in Scotland still eat too much salt, despite a reduction in recent years, so cutting the amount of salt in our diet as well as increasing physical exercise are key measures in maintaining a healthy blood pressure.

I once again thank Maree Todd for the opportunity to debate this important issue and—given the demographics in the chamber—I reiterate once again the importance of members, including me, getting our blood pressure checked. As Maree Todd said, it is important that people know their numbers and if those numbers are as high as the numbers that Stewart Stevenson and David Torrance quoted, we need to make sure that they get the help and support that they need.

The Deputy Presiding Officer:

I call young Aileen Campbell to respond to the debate.

Photo of Aileen Campbell Aileen Campbell Scottish National Party

Thank you. I was going to address that point later but, for the record and for Colin Smyth’s information, I think that I, Anas Sarwar, Monica Lennon and Tom Arthur—I do not want to offend anyone—are all under 40. Maybe we are all suffering from a lack of sleep, and Colin Smyth has taken the sleep lines for age lines.

Photo of Brian Whittle Brian Whittle Conservative

I was thinking about making a point of order.

Photo of Aileen Campbell Aileen Campbell Scottish National Party

More seriously, before I respond to the debate, I pay tribute, as Anas Sarwar and others did, to all the health and social care professionals who are doing so much to help those devastated by the brutal effects of what happened in Manchester last night. Our thoughts and prayers remain with everyone in Manchester and our gratitude goes out to the brave staff who are doing what they can to help others.

I am pleased to take the opportunity to raise awareness of hypertension and the work that is being done by the Scottish Government, NHS Scotland and others to prevent and treat it. I thank Maree Todd for bringing the debate to the chamber.

I specifically thank the British Heath Foundation, which is an active contributor to our national advisory committee on heart disease and a partner in our out-of-hospital cardiac arrest strategy. The BHF does much in terms of research and, earlier this year, I had the pleasure of visiting at Little France its centre of research excellence in the University of Edinburgh. I also recognise the work of Professor Rhian Touyz from the institute of cardiovascular and medical sciences at the University of Glasgow. She is eminent in the field of hypertension and will no doubt continue to inform our approach to the condition.

Others have reflected on what hypertension is and on its impact on people. It often has no symptoms, but it is a risk factor for heart disease and stroke—major causes of death in Scotland—and it could be prevented.

A crucial point throughout Maree Todd’s opening remarks and in the speeches of Donald Cameron and others was about the devastating knowledge that so many of Scotland’s poor health outcomes can be avoided. Not avoiding them is costly for the public purse and has an effect on those who are suffering.

Overall, 28 per cent of people in Scotland have high blood pressure, and we know that prevalence increases sharply with age. Almost two thirds of people who are over 75 have high blood pressure. It is heartening that, between 2011 and 2013, the rate of hypertension in the Scottish population decreased significantly from 33 to 28 per cent, and the figure has remained level since, but we continue to take actions that will contribute to further lowering the incidence rate.

In Scotland, the prevalence of the risk factors for hypertension is high. I will talk about our action to tackle lifestyle modification, which Brian Whittle and others mentioned, but first I highlight our approach to diagnosing and managing hypertension in primary care. We expect GPs to consider routinely checking the blood pressure of people without symptoms or existing conditions who are over 40. In addition, GPs and their staff will check blood pressure when they see patients with a wide variety of symptoms. That can be part of the monitoring of people with long-term conditions such as hypertension and diabetes as well as those who have experienced a stroke.

We are raising awareness of hypertension so that people know what they can do. NHS Inform has information on prevention, symptoms, diagnosis, treatment, complications and who to ask for help. For NHS Scotland clinical staff, HEARTe, or heart education awareness resource and training through e-learning, and STARs, or stroke training and awareness resources—both of which are part funded by the Scottish Government—offer e-learning resources in cardiovascular disease risk management, including hypertension.

Our population health improvement actions on alcohol, diet, physical activity and tobacco will also contribute to reducing the incidence of high blood pressure. Prevention is not just a key part of our approach to hypertension; it is also a key part and plank of our health and social care delivery plan, our national clinical strategy and the realistic medicine approach that the chief medical officer has outlined.

Colin Smyth made a point about exploring all avenues to identify high blood pressure. To give him some comfort on that, one example comes from the annual checks for diabetes, which we have promoted through our community pharmacy campaign. That involves nine checks, one of which is of blood pressure. We are using all avenues to promote positive health outcomes and ensuring that we have tangible things that community pharmacists and other health professionals can do to help to increase good health.

Limiting alcohol consumption can lower the risk of developing hypertension. Our alcohol strategy’s framework for action is a package of more than 40 measures to reduce consumption, encourage more positive attitudes and choices and improve treatment and support services. Our refreshed alcohol strategy will be introduced in the summer and will focus on embedding and building on the framework.

We continue to believe that a minimum unit price for alcohol, as part of a range of concerted measures, is the most effective and efficient way to tackle alcohol misuse in Scotland. Minimum pricing will target heavy drinkers, as they tend to drink the cheap high-strength alcohol that will be most affected by the policy. We continue to be disappointed by the delay to minimum unit pricing, but we remain committed to the policy and we will continue to defend it in the Supreme Court. We have given an undertaking not to implement minimum unit pricing until the judicial process is fully determined but, if the Supreme Court finds in our favour, we will seek to implement the measure as soon as possible.

We know that a poor diet increases the risk of high blood pressure and we are investing in a range of programmes to improve diets in Scotland. We are promoting healthier eating as a simple and affordable choice for all in Scotland through our eat better feel better social marketing campaign. We fund the healthy living award and the healthy living programme, which support caterers and retailers to make healthy choices more easily available through the provision of guidance, support and training. We will bring forward our diet and obesity strategy, in which we will learn the lessons of the bold measures that we have taken on alcohol and smoking, which have made the impact that we desired. Maree Todd and Colin Smyth referred to those issues.

It is not just what we eat and drink that can help to reduce the risk of developing hypertension—what we do makes a difference as well. Being active has many health benefits and can reduce the risk of developing hypertension and other chronic conditions. A fifth of adults in Scotland are inactive, but addressing that requires lots of action by many of our partners. We will continue to put effort into that and to do something in all settings, as is set out in the Toronto charter for physical activity.

In addition to its many other health benefits, not smoking can help to reduce the risk of developing hypertension and other illnesses. We will therefore continue our efforts to reduce the number of people who smoke.

We welcome the contribution of those who seek to raise awareness of hypertension, and we remain committed to ensuring that the NHS builds on its commendable achievements in detecting hypertension and treating people who have it. We will also learn where we can do more, which includes through raising awareness, as members have done in the debate.

Today’s debate has been informative. As a Parliament, we have collectively raised awareness of hypertension, and we will continue to work across party-political lines to do so. We have also learned that Stewart Stevenson likes to read death certificates, that Brian Whittle can often be found running in the woods while listening to AC/DC and that David Torrance continues to avoid branch meetings. We have learned an awful lot.

Alongside continuing the work that I have outlined on the preventative measures that we are taking to ensure that people can lead healthier lifestyles, we will continue to pursue preventative action to reduce the risk of people in Scotland developing hypertension in the future. That will contribute to better outcomes, a better quality of life and, ultimately, the healthier Scotland that we all wish to see, regardless of which political party we are here to represent. I thank Maree Todd and other members for contributing fully to this important debate.

Meeting closed at 17:51.