Intended for healthcare professionals


Effect of social deprivation on blood pressure monitoring and control in England: a survey of data from the quality and outcomes framework

BMJ 2008; 337 doi: (Published 29 October 2008) Cite this as: BMJ 2008;337:a2030
  1. Mark Ashworth, clinical senior lecturer1,
  2. Jibby Medina, research associate2,
  3. Myfanwy Morgan, reader in sociology of health2
  1. 1King’s College London, Department of General Practice and Primary Care, Division of Health and Social Care Research, London SE11 6SP
  2. 2King’s College London, Department of Public Health Sciences, Division of Health and Social Care Research, London SE1 3QD
  1. Correspondence to: Mark Ashworth mark.ashworth{at}
  • Accepted 31 August 2008


Objective To determine levels of blood pressure monitoring and control in primary care and to determine the effect of social deprivation on these levels.

Design Retrospective longitudinal survey, 2005 to 2007.

Setting General practices in England.

Participants Data obtained from 8515 practices (99.3% of all practices) in year 1, 8264 (98.3%) in year 2, and 8192 (97.8%) in year 3.

Main outcome measures Blood pressure indicators and chronic disease prevalence estimates contained within the UK quality and outcomes framework; social deprivation scores for each practice, ethnicity data obtained from the 2001 national census; general practice characteristics.

Results In 2005, 82.3% of adults (n=52.8m) had an up to date blood pressure recording; by 2007, this proportion had risen to 88.3% (n=53.2m). Initially, there was a 1.7% gap between mean blood pressure recording levels in practices located in the least deprived fifth of communities compared with the most deprived fifth, but, three years later, this gap had narrowed to 0.2%. Achievement of target blood pressure levels in 2005 for practices located in the least deprived communities ranged from 71.0% (95% CI 70.4% to 71.6%) for diabetes to 85.1% (84.7% to 85.6%) for coronary heart disease; practices in the most deprived communities achieved 68.9% (68.4% to 69.5%) and 81.8 % (81.3% to 82.3%) respectively. Three years later, target achievement in the least deprived practices had risen to 78.6% (78.1% to 79.1%) and 89.4% (89.1% to 89.7%) respectively. Target achievement in the most deprived practices rose similarly, to 79.2% (78.8% to 79.6%) and 88.4% (88.2% to 88.7%) respectively. Similar changes were observed for the achievement of blood pressure targets in hypertension, cerebrovascular disease, and chronic kidney disease.

Conclusions Since the reporting of performance indicators for primary care and the incorporation of pay for performance in 2004, blood pressure monitoring and control have improved substantially. Improvements in achievement have been accompanied by the near disappearance of the achievement gap between least and most deprived areas.


  • We thank Stevo Durbaba for help in preparing the database and Roger Jones for helpful advice on the manuscript.

  • Contributors: MA and MM conceived and designed the study; JM conducted the analysis; MA wrote the first draft of the paper. All authors contributed to writing the paper. MA is guarantor for the study.

  • Funding: JM was supported by a grant from the King’s College Centre for Caribbean Health.

  • Competing interests: None declared.

  • Ethical approval: Guy’s Research Ethics Committee approved the study.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

View Full Text