Twenty-Five Thousand Missing

What the evidence says

That caveat is worth carrying, and it does not dissolve the finding. Undiagnosed hypertension is well documented nationally, the direction of the gap is consistent everywhere it is measured, and Wandsworth’s own plan treats it as a priority on that basis.

National data consistently shows people from Black African, Black Caribbean and South Asian backgrounds at significantly higher risk of hypertension than white counterparts. Among women, age-adjusted prevalence is highest in the Black ethnic group. Hypertension in these communities is also documented as more often underdiagnosed and less well controlled once found.

A hypertensive disorder of pregnancy roughly doubles a woman’s later risk of heart disease and stroke, and makes her around four times more likely to develop hypertension after the birth. NICE recommends a medical review six to eight weeks postnatally. Beyond that point the marker frequently disappears from view, and it does not appear in the general cardiovascular risk calculators used in primary care.

Blood pressure also rises after menopause as oestrogen’s protective effect on blood vessels reduces. Post-menopausal women experience cardiovascular events at lower blood pressure thresholds than the general population.

Against that, the British Cardiovascular Society has published a consensus that cardiovascular disease in women is underdiagnosed and undertreated, with clinicians holding a lower perception of cardiovascular risk in women and women less likely to be prescribed medication.

What we could not verify

• Two figures were dropped. An earlier draft carried undiagnosed hypertension rates of 37% and 20.8% attributed to specific ethnic groups. Two summaries of the same underlying study attach those percentages to opposite groups, so neither attribution is usable. A projected prevalence figure of 82% was also dropped as implausible for a general population and probably drawn from a selected clinical cohort.
• Wandsworth’s hypertension figures are not broken down by sex or ethnicity in the source consulted. The position of women from ethnic minority and Muslim communities within the local gap is inferred from national patterns.
• The Lambeth result is a service evaluation, not a trial. It is good evidence that the approach can work and it is not evidence of what it would achieve here.

Why this matters for funding

• The delivery mechanism is already built and already used. Communi-TEA runs blood pressure checks now. This is a case for continuing and extending something with a track record, which is a materially easier ask than starting one.
• There is a comparable NHS precedent with a published result. Lambeth removed a 12 point control gap through community outreach to the same communities.
• The unit cost is close to trivial. A monitor, a volunteer, and a quiet corner. Cost per person checked will compare favourably with almost any clinical alternative.
• The pregnancy angle is genuinely under-served. A woman who had pre-eclampsia fifteen years ago is carrying a documented risk marker that her current risk assessment does not ask about. Asking is free.

The honest measure is the number of women checked, the number referred on, and how many of those turned out to have sustained high readings. A count of checks is an output. Confirmed new diagnoses would be an outcome, and would require the GP end of the loop to report back.

Sources