Exploring patient experiences of remote high blood pressure management in Scotland during COVID-19

This blog was written by Dr Sheona McHale, Research Fellow, School of Health and Social Care, Edinburgh Napier University British Heart Foundation Logo

The study discussed in this blog is funded by the British Heart Foundation.

25% is written in the middle of a circle.High Blood pressure can increase your risk of having a heart attack or stroke. If you can lower your blood pressure by 10mmHg, you can lower your risk of stroke by 25%. Find out about whether about whether you are at risk of stroke because of your blood pressure here.

The COVID-19 pandemic forced changes to healthcare delivery, which particularly affected the management of long-term conditions such as high blood pressure in GP surgeries. Telemonitoring is a way to monitor blood pressure without the need to visit your GP. It allows you to take your blood pressure at home and share your readings with your healthcare team via text or the internet. This is convenient and has been shown to improve blood pressure control.

In our study we wanted to understand how people diagnosed with high blood pressure experienced the delivery of a hypertension service during COVID-19. We were particularly interested in exploring people’s views and experiences of using remote home-based blood pressure monitoring technology and what they thought about going to hospital during the pandemic.

We wanted to learn how people diagnosed with high blood pressure accessed healthcare to manage their condition during a time when routine services were severely disrupted due to COVID-19. Also, we wanted to explore the experiences of patients within NHS Lothian primary care centres who used remote blood pressure telemonitoring to self-manage their high blood pressure during COVID-19 and to compare these to the experiences of patients who did not have access to blood pressure telemonitoring during the pandemic.

We designed a study to gain insight from asking people questions during a telephone interview. The telephone interview allowed us to gain personal views and experiences from high blood pressure patients managed in primary care within NHS Lothian, and who gave their consent to take part in the study.

A drawing of a blood pressure monitor.We planned to identify and recruit 40 participants via the NHS Research Scotland (NRS) Primary Care Network (20 participants who had experience of telemonitoring technology and 20 without access to telemonitoring technology). Potential participants were identified from clinical records and provided with study information packs. At this point in time, we have not completed the recruitment stage of the study. Upon completion of study recruitment, we aim to analyse the personal views and experiences of participants to help us understand how those diagnosed with high blood pressure accessed healthcare to manage their chronic condition during the C0VID-19 pandemic.

This study is led by Dr Janet Hanley, Associate Professor, School of Health and Social Care at Edinburgh Napier University. If you would like further information, please contact

Sheona McHale, Research Fellow,

Centre for Cardiovascular Health, Edinburgh Napier University,

Tel: 0131455 3476

Email: s.mchale@napier.ac.uk

New World Health Organisation report of walking and cycling: Do we really need any more updates?

This blog was written by Dr Adrian L Davis, Professor of Transport & Health, Transport Research Institute at Edinburgh Napier University.

Since a few early studies, including the UK Whitehall Study (started 1967) which especially focused on cardiorespiratory disease prevalence, and a Birmingham male factory workers study (1986) of commuter cyclists, there began a trickle of evidence suggesting that walking and cycling provide significant health benefits. The headline was reduced all-cause mortality and for cycling higher fitness levels equivalent to being five to ten years younger. Then, from around 2000 there was a sharp increase in peer reviewed research, likely led by sport scientists getting more interested in population health. Then other scientists got interested.

Simple graph representing the increase of published research on walking and cycling, from 2000 to 2020.

So, why this new World Health Organisation (WHO) report? Well, the four main premises are:

  1. These are good times for advancing walking and cycling
  2. Walking and cycling are central to urban mobility – rather than an afterthought
  3. Research provides a strong case to promote walking and cycling
  4. Practice provides a rich portfolio of measures to promote walking and cycling

The target audience is firstly policy makers by providing support to make the case for more walking and cycling. Secondly, it’s for practitioners by providing an overview of effective measures. Thirdly, advocates can draw on this evidence to help develop a narrative of the most compelling arguments in favour of walking and cycling. Fourth, it’s also accessible for general readers as we take you through the breadth of research findings with further readings references.

Why now? There are quite a few good reasons, not least: COVID-19 and the lessons that travel patterns can change quickly and so can some infrastructure; more urgent Climate change challenges; electrification and E-bikes, other technological advances; and the need for equity in transport. Taking e-biking, the battery energy support and the expanded km range etc, has led to a broader demographic market, including those long-ago lapsed cyclists aged 60+. Across Europe we continue to witness substantial sales growth. That’s the up-side. On the downside we also see that e-biking is about twice as risky as cycling (based on Swiss data).

More generally, we must address perceived and actual harms which starts with road danger. Higher safety can be achieved through infrastructure and traffic regulation, a prerequisite for higher walking and cycling levels. In terms of air pollution, the evidence remains that physical activity benefits outweigh harms from pollution exposure although we must deal with this issue. In putting benefits and harms into perspective we highlight the increasing value of the Health Economic Assessment Tool. The HEAT is designed to enable users without expertise in impact assessment to conduct economic assessments of the health impacts of walking or cycling. Case studies are included. We hope they inspire. Just look at Seville (p 67), for example, to see what can be achieved with political will.

We conclude that a rich body of evidence finds that there are substantial benefits accruing from walking and cycling, for individual and population health. Moreover, their role in replacing existing car trips, helping move towards carbon-free mobility, is increasingly recognised. The challenge: current planning practice needs to realign prioritisation of travel modes regarding funds and space away from private cars and recognise active travel as central – not an afterthought – to meeting a broad set of policy goals including health and sustainability. Ending on a personal note, we largely know the infrastructural measures needed, we have to work hard to resolve the human behaviour challenges – embedded as they are in cultural norms – and re-enforced by spatial planning. In Scotland government policy is reflecting better the evidence-base although that does not alone guarantee success. We all need to take meaningful action, as advocates, and in how we choose to move around.

Read the full WHO report here: Walking and cycling: latest evidence to support policy-making and practice (who.int)