Treating high blood pressure in Black African and Caribbean communities

Treating high blood pressure in Black African and Caribbean communities
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Tracey Bignall from the Race Equality Foundation discusses the Share the Pressure project which is treating high blood pressure in Black African and Caribbean communities.

Everyone wants to enjoy a healthy life. We all want to look after our heart and protect it from the risk of disease and long-term health conditions.

Cardiovascular disease (CVD) is a general term for conditions affecting the heart or blood vessels and includes hypertension, commonly known as high blood pressure. We know that some people are at greater risk of certain conditions and people from Black African and Black Caribbean communities unfortunately are more likely to develop high blood pressure, but what is less known is how the condition is understood and managed within these communities. We, at the Race Equality Foundation, are leading an innovative project to help Black African and Caribbean people make decisions on how to manage their blood pressure.

Cardiovascular disease is one of the largest contributors to health inequalities and people from South Asian and Black groups have the highest risk of cardiovascular disease. We know from the COVID-19 pandemic that people with cardiovascular disease also had a higher risk of getting COVID-19 with poor experiences and outcomes. There is a real need to reduce the number of people affected by cardiovascular disease particularly as it is largely preventable and can be managed. Our focus is on treating high blood pressure.

High blood pressure is often known as a ‘silent killer’ because most people show no symptoms. It affects one in four adults in England, and more than 4.3 million people in England with high blood pressure go undiagnosed and untreated. If left untreated, high blood pressure increases the risk of heart attacks and strokes. But early detection and treatment can help people live longer.

The importance of testing blood pressure

It is unclear why Black African and Caribbean communities have a higher risk of developing high blood pressure; it is likely a lack of diagnosis is a contributing factor. There are also questions about poor management of the condition once diagnosed. Research has also identified a lack of knowledge about the condition, and certain beliefs about the condition and symptoms including that hypertension and high blood pressure are two different things; that it is part of ageing and cannot be prevented and a diagnosis will mean a lifetime of medication, amongst others.  We also know that healthcare messaging does not always engage these communities well.

Challenges to engaging with Black African and Caribbean communities have been raised, such as a lack of trust in healthcare, not having appropriate materials to reach them, and the type of approach used to appeal to them. But community approaches have been shown to engage well with Black African and Caribbean communities. There are examples where improved health messaging and better engagement have worked with health interventions for people from Black communities. One of these is our community approaches to addressing high blood pressure in Black African and African Caribbean men project. This work raised awareness and undertook blood pressure testing by engaging Black African and Caribbean men in community settings, such as barbershops.

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People also need to be able to make informed decisions about their health and managing health conditions. The Heart Age Tool is an online risk management programme where individuals can get a tailored report to make informed decisions about how to lower their blood pressure and improve their health.

We are pleased to be building on both of these previous projects to deliver a new innovative project funded by the Burdett Trust.

The Share the Pressure project is aiming to contribute towards the narrowing of inequalities associated with cardiovascular disease that exist in Black African and Caribbean communities, by treating high blood pressure.

Inequalities in high blood pressure treatment

The Race Equality Foundation aims to improve the lives of Black, Asian and minority ethnic communities by addressing racial inequality in public services. A focus has been on the ethnic health inequalities experienced by these communities. We are therefore delighted to be working with our partners Smart Health Solutions, Younger Lives and Blood Pressure UK to deliver the project.  Through the project, we will carry out community blood pressure testing and use an online tool to identify an individual’s risk of developing high blood pressure and enable shared decision-making on how to manage it, in consultation with healthcare professionals. We will be working in community settings and at health events to provide opportunities for these communities to check on their health.

This project is timely, as it comes when we are in a new phase of how health and care services are organised and provide new opportunities to tackle health inequalities. NHS England describes Integrated Care Systems as ‘partnerships of organisations that come together to plan and deliver joined-up health and care services, and to improve the lives of people who live and work in their area.’ We will make the most of opportunities within this new structure for a wider reach and impact on Black African and Caribbean communities. Working in the new Integrated Care System will enable our project to develop a new pathway for treating high blood pressure, as well as detection and management. The project will also see better use of digital technologies designed to communicate cardiovascular risk and shared decision-making for patients and train healthcare professionals in its use.

We will be working across the South East London Integrated Care System which includes the London boroughs of Southwark, Lambeth, Lewisham, Green, Bromley and Bexley.

The project, which will run until 31 August 2023, will consist of developing and piloting a nurse-led motivational change model for managing and treating high blood pressure that reaches and impacts people at greater risk of this condition. This will involve:

  • Treating high blood pressure within the community;
    • The development of the Heart Age Tool specifically focused on Black African and Caribbean communities;
    •    Training healthcare professionals to deliver the programme; and
    •    An evaluation of the programme.

This project will contribute towards one of the aims of the NHS Long Term Plan in reducing the number of people affected by cardiovascular disease and the costs to the NHS. More timely, as this is impacting the NHS Core2PLUS5 national campaign to reduce health inequalities which all integrated care systems should be following. One of the five clinical areas they focus on is hypertension case-finding and optimal management and lipid optimal management. Priorities concerning the early detection and treatment of CVD can help patients live longer, healthier lives and, where individuals are identified with high-risk conditions, appropriate preventative treatments will be offered in a timely way. Additionally, our project will add to the growing number of different approaches taking place within local communities facilitating access to health information, testing and decision-making that will impact behaviour change and ultimately healthy lives.

Please contact Tracey Bignall, Senior Policy and Practice Officer via email: for further information.


Bignall, T and Yigit, D, 2020, Community approaches to addressing high blood pressure in black African and Caribbean males project Evidence review, Race Equality Foundation

NHS England, 2019, NHS Long Term Plan

NHS England, no date, What are integrated care systems?

NHS England, no date, Core20PLUS5 (adults) – an approach to reducing healthcare inequalities

Raleigh, V, Jefferies, D and Wellings, D, November 2022, Cardiovascular disease in England: supporting leaders to take actions

Thompson, K and Sullivan, H, 6 September 2021, Blood pressure: Are your pipes in good working order? UK Health Security Agency

Tracey Bignall
Senior Policy and Practice Officer
Race Equality Foundation!/raceequality 

This article is from issue 24 of Health Europa Quarterly. Click here to get your free subscription today.

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