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Good afternoon and welcome to this share the pressure session on BP and lifestyle. My name is Joanne Horse. I'm the clinical Director of Smart Health Solutions and have a number of other jobs as well. And this live webinar is part of our share the pressure series, which is a project we're working on with our partners, the Race Equality Foundation, Younger Lives and BP UK, which is funded by the Burdette Trust for Nursing. And this is a project that's aiming to address high BP among Black African and Caribbean people using a shared decision making tool. As I say, today's focus is on BP and lifestyle. This webinar is available to view on demand or will be when I finished today. So welcome. If you are joining us on demand, this session is also going to be run again live on the 15th of April at midday. So if you do want to join another live session where you'll have the opportunity to ask any questions and make any comments, then please make a note of that in your diary and you can register to attend by our website which is smart health solutions dot co dot U K. So I'm delivering this series with my colleagues, uh Michaela and David who are both involved in this project. And there's a number of resources that are available and I'm gonna take you through and show you what some of those are a little bit later on. Uh You're on the let the Medal platform live at the moment and our friends at Medal are Justin credible in terms of the platform that they've provided for healthcare education. So as well as viewing this webinar, now, you will also be able to access the slides that I'm using. Watch the webinar on demand, but also generate a certificate of attendance that you'll be able to use for your professional portfolio, your revalidation or whatever is that you need and you'll see down in the right hand corner when you go on to medal. In fact, it's there. Now, I can see it, there's a little live chat. So if you're having any problems with the medal at all, you pop a message in there, the team will get back to you as soon as possible. So why are we looking at BP and why are we looking at BP specifically in Black people of African or Caribbean descent? So we know that ethnicity is a significant risk factor when it comes to cardiovascular disease. We know that people of South Asian origin are disproportionately affected by diabetes and by coronary heart disease and we also know that high BP disproportionately affects black people of African or Caribbean descent. And in this population, as a result of this, we see a higher incidence of stroke and of end stage renal failure. We also know that black people are less likely to come forward for routine screening and health checks than their white counterparts. And this does affect men in particular. And even when the diagnosis is made, black people are less likely to have good control of their BP again than white people. So there's a real health inequality in there. It wasn't great in the first place, but COVID 19 has made this situation significantly worse. And I'm sure you're aware of the disproportionate burden um of COVID 19 in Black people and also in Asian people as well. So again, we know that ethnicity has a big impact on our overall health outcomes. So onto the subject of lifestyle. Well, lifestyle recommendations are present in all of the major guidelines. We are looking at this project. So we're working particularly with the population of South East London, though these webinars are accessible to other people around the world that may want to look at them. So our National guidance here, we'll be looking at the nice guidelines and they recommend that guidance and advice is offered around diet and exercise, around alcohol consumption and around smoking. And also that we provide patient's with information about drug treatments and the side effects, the benefits of these details of patient organizations. And also that all people with persistent high BP or hypertension are offered an annual review of their care. So I mentioned that we are working with South East London uh integrated care system specifically on this. And they have some amazing guidance around the pressure around the management of hypertension, which is really in depth and tells you everything that you need to know. So if you've not already accessed this guideline here is what it looks like. Now, there is a specific version for each borough within South East London pulled together by the clinical effectiveness, Southeast London group. The one that I selected here is the Lambeth guide. But as I say, there is one for each borough and within each, you'll find links and information that are specific to that individual borough. But as you can see, lifestyle is a really important factor here and it is within the key messages on the front page of all of these clinical effectiveness guidelines for Southeast London, just reinforcing that style changes can prevent or reduce the need for medication and that we should be encouraging and supporting patient's with their lifestyle changes and that these should be reviewed at least annually. So what is it in terms of lifestyle, what works and you know, how much impact does it really have? Because the problem with lifestyle changes is you've got to do them and then once you've done them, you've got to keep doing them, which the of us will find a challenge. I'm sure I'm not the only person that's started on a healthier lifestyle regime and then promptly melted back to my old ways after a few weeks. However, this isn't just stuff that we recommend to people because it feels like a good idea. There is a wealth of evidence on the effectiveness and impact that lifestyle changes can have directly on BP. Now, this table is within the Southeast London guidelines. But you know, this has been reproduced and publishing multiple areas. And you know, this is looking across a number of studies, looking at the impact of lifestyle changes, what the recommendations are and the impact that they can have in terms of the reduction in systolic BP. So these five key things are the ones that are of most importance when it comes to lifestyle and the changes that they can make. And you'll see that the reductions in blood pressure can be as good as or in many cases better than any anti hypertension medication that we could offer. So if an individual has weight to lose by actually maintaining a healthy body, you can achieve up to a 20 millimeters of mercury reduction in your systolic BP. Now, this is associated with a loss of about 10 kg in weight, which is a significant amount, but it is all proportionate. And if people do have weight to lose any headway that they can make in losing weight will make a positive difference to their BP. In terms of diet, we know from the dash diet, which was years ago. Now the dietary approaches to stopping hypertension study there, a diet that's rich in fruit vegetables, low fat dairy products with reduced saturated and overall fats achieves can achieve up to a 14 millimeter of mercury reduction. There's also a recommendation that people avoid excessive caffeine or caffeine rich products in the diet as well because that can also affect BP. But one of the key factors when it comes to our dietary intake, and most people know this about BP is that a high sodium intake, halt high salt intake can really increase your BP. And many people will say that salt is the devil when it comes to BP. So reducing your salt intake can bring up to eight millimeters of mercury off your systolic BP, which is fantastic. And of course, it's not all about the salt that we tip onto our food. It's the splits within convenience food within processed food. And often the things that we don't really think would have salt in them like cereals and bread can in fact be laden with sodium. Next thing on the list is exercise and physical activity. Now, there are specific recommendations around what we would be looking to achieve to have the maximum impact on our BP and a multitude of guidelines will recommend that we exercise in something that makes us out of breath for at least half an hour a day on most days of the week. But for some of us that may not be achievable. Um And much in the line along the lines of the losing weight, uh, any activity is better than no activity. And I'm going to talk a little bit more shortly about how we can support people with making decisions and setting goals about what's realistic for them. The fifth lifestyle impact change on here is around alcohol and we know that an increased alcohol intake above recommended limits is directly linked to a high BP. So by keeping alcohol intake within the recommended limits or ideally below the recommended limits of 14 units per week. And of course, not in one go, we can achieve a good reduction in blood pressure of up to four millimeters of mercury as well. So you can see there, there, there may be a cumulative effect of these. If people decide to tackle more than one change, it will be variable. There's no guarantee of course that if you lose 10 kg in weight, you're going to knock 20 millimeters of mercury off your BP, but it is achievable. It's just everybody's different works in different ways for different people. Some people may have even more um of a positive impact than what stated here. Some people may have less. This is information that's useful to share with people to support them in their decision making because for many people, they don't want to take medication or can't take medication for a number of reasons. It could be financial reasons, lots of, lots of reasons why people don't. So actually showing people that it's possible to make significant changes to your BP without putting any tablets in your mouth, can really help with supporting their decision making to improve their BP and improve their health outcomes. Now, as well as um sort of the direct information that's there. We also recognize that it's useful for people to have a variety of sources of support that can help them with making decisions about any lifestyle changes, with monitoring the impact of any lifestyle changes and of course, with being able to stick to them. Again, the local guidance uh this one still Lambeth um for Southeast London will have a number uh of links in each guideline that will take people to sources of local support that can help them with addressing BP. Be that around physical activity programs. Uh walking schemes, dietary advice down to pharmacies where you can go and get your BP checked. You know, there's lots of information in there and specifically in this one, directing Black and Asian people to a dedicated Wellness Clinic to help find any potential long term health conditions and problems that they may have so lots of stuff that's available to support people with making a difference and hopefully improving their health and well being. Now nationally, we have partnered up with BP UK. It's the only dedicated charity in the UK that is for lowering BP to prevent strokes and heart disease. And as mentioned at the beginning, this disproportionate effect of high BP in people of Black African and Caribbean descent does mean that there is an increased rate of strokes in this population that leads to people being up well being did, disabled, being unable to work and ultimately dying earlier than they should, should do and leave families bereaved much earlier than they should do. So BP UK are doing some fantastic work across the nation and have some amazing resources for the whole population that can be helped in providing information about BP and what you can do to improve your BP and improve your overall health. So lots of information there for patient's for the public. There's also some really good stuff, really good resources for healthcare professionals as well. So I do have a look at them and see what's available. Now, of course, giving the information is only one part of story. Um Nobody likes to be told what to do. And so the godfathers here of motivational interviewing behavior change. I I love this quote which is 20 years old now that probably sums me up to a T if you're told what to do, there's a really good chance that you'll do absolutely the opposite. And hopefully as healthcare workers and as people, we are no, nowadays that telling people what to do is not a great move and it probably isn't going to result in much in the way of lifestyle changes. In fact, we often refer to it as a lifestyle advice. But what we really want to do is give people information, good information with an evidence base that can be backed up with literature with takeaway pieces of information that people can use to inform themselves and to make decisions that are gonna work for them. So things that are realistic, things that are specific enough, so they know what they're going to do and things that are achievable for them. Now, you may have done some study of behavior change and motivational interviewing and there's a wealth of literature out there, a wealth of evidence around what can be really helpful in influencing people to change and uh in a learn with nurses uh series that some of you may have joined in the past. I did a fantastic session with Jan Proctor King and Alison Oldham just into the new year on informational interview and support people to change their behavior. And that is available on the learn with nurses website. If you want to have a look at that, that's their on demand, gives you some really helpful tips, things that make you think about what's really useful and what can be really helpful in the short period of time that we have with people when we might want to give them information that will try and help them to make healthier choices when it comes to their lifestyle. And that's really um where our share the pressure project comes in. So it's partly about raising awareness of this particular issue in black communities, but also offering some solutions and support of what could actually help um us in dealing with this population in terms of the support that we give. So on our website, uh smart health solutions dot co dot UK, you will find a link to the share the pressure uh web pages which are full of resources and provide a direct link to the share the pressure website. Now share the pressure has been around as a as a tool for a few years. Now, we've not tested it in specifically a black population until now. So we have done lots of work and you may have seen Michaela's webinar last week, I think if not, it's their on demand which tells you all about share the pressure, the program, the web page and how to use it. Um So do you go back and have a look at that? But this is the page that will come up with some options to go through resources for yourself, for healthcare workers, healthcare nationals, for patient's and the link through to the share the pressure website. And if you saw Michaela's webinar or you already know about share the pressure, you'll know this is about shared decision making and it's built all around the concept of heart age. And so heart age uses your cardiovascular risk factors to um come up with a heart age. And this is a, a calculation, an estimation of how old your heart is in relation to your real natural chronological age based on the risk factors that are present in your life. So it's about informing people about their risk in a way that hopefully is easy to understand. Um and then giving people information which they can use upon which to base their decisions. So there's a couple of minutes of minute assessment in there that people will put in all of their information about their risk factors. Um So, oh my slides are jumping around here. So once people can do this with a healthcare professional with a healthcare worker, they can take it and do it on their own at home, they need some information to put in it. But if they have their BP and they'll obviously know how old they are, what their gender is, what their ethnicity is. They can get a personalized report that will come out of this and some suggestions of information that they may want to have a look at that could make a difference to them. And it will also direct around whether they perhaps would be useful for them to get their BP recheck to see a healthcare professional and suggest some questions that they may want to think about before doing so. So the share the pressure shared decision making tool can be really, really helpful in that whole process of people finding out information, finding out whether they are re ready to think about making changes to their lifestyle, to improve their outcomes, whether they feel confident that they'll be able to do this and what they're willing to think about in terms of changes. Because we've seen there's lots of advice that can help your BP, but some of it you may not want, it may not be relevant for you at that time. It may not be something that you want to tackle, but you may be prepared to move on and look at the next piece of information and possibly make a decision on that. So this tool can be really helpful part of discussion's with people when they first find out they have high BP or as they go further along their journey with their high BP, because of course, the whole bit about giving the information and having the discussions about it doesn't just happen at the time of diagnosis. It is an ongoing thing. And you might recall, I said at the beginning when I was showing the nice recommendations that everyone with high BP with hypertension, regardless of whether or not they're on any medication should be offered at least an annual review of their care. And the South East London guidelines here give an amazing step by step guide as to what needs to be covered within that hypertension review. And it's much, much more than just having a BP check. So obviously having a BP check, blood tests and all those kind of things is in there. But it very much concentrates on the review of the patient to include any symptoms that they might be having about the checks that need to be done. But also a point around discussing risk reduction and lifestyle specifying weight, smoking, alcohol, diet, physical activity, and also has added in COVID here and also recommends that we think about mind and body. So overall health and well being is really important in this because somebody is in a really bad place in their life at this time, then they may not really be able to or be willing to think about making lifestyle changes at that time. So it's important to think about people as a whole and what their priorities are and provide information to help them make their decisions rather than making an assumption that everybody will be able to do these things if we just tell them what to do. So we know that that doesn't work. And the guidelines also recommend that shared decision making is a part of this and that it really is a team effort. It's not about necessarily just being gps that deal with this or practice nurses that deal with this. We also have our wider teams within our pa primary care networks. Um And that goes out into the community as well and our community pharmacy colleagues can be absolutely instrumentals in supporting people with high blood. Uh And we know that there are a wealth of community programs going on out there as well. So do have a look and see what's available in your area and see what resources there are to help your patient's because this is a big issue and it does take a whole population approach to be able to make a difference. So for healthcare professionals, we have our community of practice, it, practice, sorry, that's accessible via our website as well. Might be where you signed up to this webinar today. But we have a variety of resources available on there for learning and development for all healthcare workers. So we've got lots of webinars including this one. Um as we do them, they're all available, they're on demand to watch. So do catch up with any that you may have missed. We've also got another round of live webinars coming. So you can book yourself onto any of those. If there's anything that takes your fancy as well as our traditional webinars, we also have some podcasts available to you. So if it suits you better to be listening while you're on the school run or having a bath or making the dinner or whatever it may be. Then there is an opportunity to listen to some short snappy easy listening podcast that have got a lot of the same information. And we've also got some links to articles that we've written as part of this project and the all important link to the guidance for Southeast London with one for each of the boroughs that you'll be able to access via there as well. So, do you have a look, see if there's anything there that's of interest to you? Um Because lifestyle can really have a huge impact on BP as you've seen in the evidence that I've presented in that chart of what it can actually do in terms of lowering BP numbers. And as completely supported by Southeast London Lifestyle management really is a key strategy for BP management and the effects can be even greater than some of the BP medications that we can give. But it's all about the delivery and about supporting people to make decisions around their lifestyle that are realistic that are gonna work for them and they're going to be able to stick to uh to make a difference because we know that BP is directly responsible for a lot of people being very ill and dying before their time and families losing loved ones. And this is something that is a particular burden in our Black African and Caribbean communities. So there's a real health inequality slant here that we must address. We have all the tools available to us to detect high BP and to manage high BP. So there's work to be done and we must do it and we all have a role that we can play in that. So, thank you very much for your attention. Um If you're on a live webinar, there's always an opportunity to ask questions if you're watching it on demand less. So, so if you've got any questions, please sign up to the next live webinar or alternatively, you can contact via the smart health solutions website too. So uh please complete the evaluation. Let us know if you found this uh session useful or not and we'd love to hear from you if there's anything else that you would like to see in, share the pressure that will help you to make a difference to your local population. So, thanks very much for joining me and we'll see you again soon. Thank you. Bye bye.
