HYPERTENSION TEACHING IN SCHOOLS

An intergenerational approach to learning about blood pressure 

Dr Daniel Mason CCPL CVD Frimley ICB, Claire Norfolk Head of Longterm Conditions Frimley ICB, Mahmuda Ullah Frimley ICS Head of Prevention and Health Inequalities, Olly Hemans Communications and Engagement Manager NHS Frimley,  

Supported by Frimley ICB Cardiac Network  

Summary 

Hypertension (high blood pressure) is a significant, often silent, risk factor for cardiovascular diseases such as myocardial infarction (heart attack), and stroke. Hypertension often goes unrecognised and undiagnosed in the community, especially where health care access and health education is limited. This project aimed to deliver teaching to students in year six of education with the goals of educating the individual and empowering them to have conversations about blood pressure within their family and social circles. Students were encouraged to spread their learning within their families thereby raising community awareness and encouraging adults to seek screening for elevated blood pressure, whilst also mitigating areas of possible challenge such as language and cultural barriers to health care education.  

Cardiovascular disease levers a large burden on patients and services and costs the NHS approximately £12 Billion per annum. Within Frimley ICS there is a pledge to prevent up to 300 stokes and 230 heart attacks per year. There is a national ambition within the NHS to increase the percentage of patients with hypertension treated according to NICE guidance to 80% by March of 2026. Adopting new and varied approaches to achieve this work is likely necessary in order to shape the landscape for further patient benefit.  

This project delivered teaching to 150 students across year six education within a Junior school in Surrey.  

The feedback from the teachers was positive and it was highlighted that the children enjoyed the lesson and demonstrated a clear understating of hypertension at the end. The lesson was pitched at the right level for year 6 and fits in well with the year 6 curriculum. 

Introduction 

Hypertension is a risk factor for cardiovascular disease including stroke, coronary artery disease and heart failure. This often-asymptomatic health condition remains undiagnosed and untreated for many in the community. This is particularly true for areas which are socioeconomically deprived and have limited access to health care and health care education. Hypertension is defined as a clinic blood pressure of 140/90mmHg or higher, or readings taken at home of 135/85mmHg or higher. Blood pressure is the third largest UK risk factor for disease after smoking and poor diet. However, with regards to cardiovascular disease and disease related disability, hypertension is the largest risk factor.  

Cardiovascular disease is also strongly associated with health inequalities, and this is evident in Frimley ICS where the gap between life expectancy between the least and most deprived areas is impacted significantly by cardiovascular disease. Prevention of the development of cardiovascular disease by addressing smoking, obesity and lifestyle factors early in the patient journey can lead to improved patient outcomes.  

Approximately one in four adults in England are affected by high blood pressure and at least half of all strokes and heart attacks are associated with hypertension. This condition therefore affects a significant proportion of the population and disproportionally impacts vulnerable and deprived populations.  

A publication in the Lancet found that within populations sampled a reduction of 10mmHg caused a 17% reduction in coronary artery disease, a 27% reduction in stroke, a 28% reduction in heart failure and significantly a 13% reduction in all-cause mortality. 

Economically to the NHS cardiovascular disease is a large burden. The total annual cost of heart and circulatory disease to the UK Is approximately £12 Billion. In the UK Coronary heart disease is a leading cause of death and around one person every 5 minutes is admitted to hospital due to a heart attack. (BHF) Approximately 30% of adults in the UK have hypertension with around half of these not being treated to approved targets.  

This project was designed to teach year six school children about causes, risks, and prevention of hypertension. The secondary aim of this work was to foster intergenerational discussions between students and their families about hypertension and empower families to seek screening, thereby identifying undiagnosed hypertension in the community. 

Educating children about blood pressure encourages them, and empowers them, to adopt healthier lifestyles including reduction in salt intake, smoking avoidance and increased exercise. These habits can significantly reduce the risk of developing hypertension and cardiovascular disease later in life and also furnish children with the knowledge required to take responsibility for their own health and act as advocates for healthier lifestyles in their communities.  

Methodology 

An objective of teaching children in year six of school education about the causes risks and prevention of hypertension was set with a secondary educational component created as a homework piece for children to work through with their parents and wider family.  

The classwork was delivered by their usual teacher and was adjustable in lesson to ensure that it was pitched at the right level, child friendly and engaging.  

A presentation was delivered in class utilising notebook presentation software. The outline of this learning was as follows with regards to know what blood pressure is and how it links to hypertension: 

1. Can I use my evidencing skills to draw and annotate diagrams for clarity and annotate effectively 

2. Can I use my technical vocabulary to describe the circulatory system and its purpose. 

   
   

By the end of the lesson students should be able to  

1. Explain what blood pressure is and why it is important for health 

2. Understand what hypertension (high blood pressure) means 

3. Identify basic lifestyle habits that contribute to maintaining healthy blood pressure 

4. Recognise the importance of heart health 

   
   

The initial part of the lesson reviewed what students knew and remembered about the heart already including where the heart is situated in the body. Students were asked to place their hands on the table and open and close their fists alongside a timer each second to replicate the pumping and timing of their own hearts.  

Students were then introduced to the concept of blood pressure. Students were asked what they already know about blood pressure, and it was then explained that  

‘Blood pressure is the force of the blood pushing against the walls of the blood vessels as the heart pumps blood through the body’ 

Some practical elements included allowing the students to use a blood pressure machine and using this to explain why there are two numbers associated with blood pressure. The top number ‘systolic’ blood pressure was described as the force when the blood is actively pushing the blood through the vessel. The bottom number was described as the pressure when the heart was ‘relaxing’. 

A method for explaining this further was to draw comparison between blood pressure and water flowing through a hose. Further to this it was explained that high blood pressure is a measure of when this pressure is too high. It was then explained that high blood pressure can cause damage to the blood vessels and make the heart ‘work’ harder which can lead to health problems as people age. 

A practical activity for demonstrating how the heart and blood pressure works was delivered which involved students marking out a short course and dividing into two groups. One group was the ‘pumping’ element, and the other group represented the ‘blood vessels’ themselves. The first group would walk at varying speeds, and run, through the opening created by the second group and discussion thereafter was facilitated by the teacher to explain that just as running makes our hearts ‘pump’ (work) harder, elevated blood pressure also makes the heart work harder which can lead to disease and poor health over time. 

Following this activity exploration was encouraged as to how you can keep your blood pressure within the normal range. Topics such as healthy diet, reduction in salt intake, physical activity, smoking or the use of vapes, and relaxation/stress reduction were discussed. A spreadsheet table was used with students to try and list as many activities as possible that could be used to help lower blood pressure and place these into groups. 

Each student was then encouraged to create an image using the outline of a heart to record a slogan and many pictures of things used to keep blood pressure within the normal range.  

The lesson was then reviewed as a summary at the end and homework set to be completed over the half term holiday break using Google Classroom. A copy of this homework sheet is included in

Appendix 1. 

Frimley ICB provided a video which was developed to be an aid to this homework. The video was an educational piece created to facilitate learning about blood pressure at approximately year six level. It is evident that this video could also be used for students in other years of education. A leaflet regarding blood pressure education for schools including this video was developed and is included below in Appendix 2.  

Homework outcomes were qualitatively analysed and responses reviewed to assess outcome for the project.  

Feeback was obtained from the head of year six who was the main point of contact through the project delivery.  

An opt out for parents who did not wish for their child to be involved in the teaching was developed and provided to parents by the school.  

Findings 

Of the 150 students who attended the lessons 40 returned homework. This was mainly due to the timing of the lesion prior to half term, where homework is not mandatory. The feedback from the school was that the children enjoyed the lesson and demonstrated a clear understanding of hypertension once the lesson was completed. It was felt by the school that the lesson was pitched correctly for year six and fits with the curriculum. 

Analysis of the homework received demonstrated that 62.5% of children completing the assignment had a family member with hypertension. 92.5% demonstrated some understanding of blood pressure and the possible complications of untreated hypertension. 80% were able to confirm that they knew where blood pressure could be checked although many answers were short and either stated simply ‘yes’ or named one area where blood pressure could be checked, for example, with your GP.  

It was demonstrable from the homework that there was intergeneration conversation and learning and 70% of responses included some change that could be made within the family to ensure ongoing healthy blood pressure and thereby reduction of risk of hypertension and poor health.  

Some comments received evidencing consideration of health, lifestyle and impact of such, not only on the individual, but on the wider family are included below. 

“I have always had good blood pressure, but I know I have to drink more water and lose weight and be fitter. This I will work on for our daughter!” 

“I learned someone from my family has a high blood pressure and I learned to limit salt intake” 

“It has made us conscious to have an open conversation about blood pressure and influenced us to have a healthier lifestyle” 

“Helped my parent realise that salt is in everything you buy and should watch how much you eat.” 

“I am more aware that my children do not eat as healthy as they could and do need to be more active” 

“I have learnt that many people in our family have high blood pressure. It has helped me understand what my family can do to reduce high blood pressure.” 

“I have learned that it’s easy to forget about your blood pressure and heart rate. As a family, we need to work on exercise and eating healthily.” 

“From this conversation I have found out that some people in my family have high blood pressure and how they manage to maintain a steady blood pressure.” 

“It is great that children are learning about anything to do with health, especially at a young age. This will also be hugely beneficial if any families suffer with high/low blood pressure, as it deepens the understanding for the child.” 

Discussion  

This project highlights how intergenerational learning through partnerships between healthcare and schools can succeed in delivering meaningful messaging and education to families to foster better long-term health outcomes. This may influence the health of the family and therefore the community by improving awareness of the possible dangers of untreated blood pressure but could be expanded to discuss other health care issues such as hypercholesterolaemia. In educating the community more widely through discussions had within families the possible barriers, visible such as access, and invisible such as perceived difficulties when speaking with health professionals, can be mitigated.  

Following the pilot project the homework piece is planned to be adjusted as it was evident that some of the questions contained could be developed further and perhaps the piece was slightly too long to be engaging at this age. This is a simple adjustment which will hopefully improve the quality of feedback. Some of the comments received demonstrated an enjoyment in this style of learning and this is something that can be developed with these adjustments.   

The engagement of the school in this pilot was excellent and the forward plan for this work is to spread this to other schools and communities.  

References

BHF UK CVD Factsheet , Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis, Health matters: combating high blood pressure - GOV.UK

Ettehad D., Emdin C., Kiran A., Anderson S., Callender T., Emberson J., Chalmers J., Rodgers A., Rahimi K. (2020). Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta -analysis. The Lancet. [Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis] [Dec 23,2015] Lancet 2016; 387:957-67

Appendix 1.  

1. Hypertension Homework 

We have been learning about blood pressure and hypertension in school. 

If your parents are willing to help, please ask them these questions: 

Task 1:

What do you know about blood pressure?

Do you or anyone in our family have high blood pressure?

What do you do to keep your blood pressure healthy?

Do you think our family does enough to stay heart-healthy? Do you know where to have your blood pressure measured?

After the interview, write 2-3 sentences about something new you learned from this conversation.

Task 2

Family Blood Pressure Tracker

With your family, choose one or two healthy habits to track over the course of a week. Examples include:

• Fruit and Vegetable Intake: How many servings of fruits and vegetables does each family member eat daily?

• Physical Activity: How many minutes does each family member spend on physical activities like walking, sports, or exercises each day?

• Create a simple table to track each family member’s progress each day. At the end of the week, discuss as a family:

• What habits were easy or hard to follow?

• How could you improve your family’s daily routines to support heart health?

Aspect to Track:

Weekly Tracking Grid:

Day

Comments

Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Task 3

Family Heart-Healthy Recipe Activity

• Objective: To learn about how food choices can impact heart health.

• Instructions: Work with your family to find or create a heart-healthy recipe. Consider recipes that are low in salt, include vegetables, or have whole grains.

• Prepare the recipe together as a family.

• Write down the recipe and take a photo of your meal if possible.

Recipe

How was this recipe healthier than what we might usually eat?

Did everyone enjoy the meal?

What other heart-healthy ingredients could we add next time?

Task 4

Creative Project: Family Heart Health Poster or Booklet

• Objective: To summarise and creatively present what your family has learned.

• Instructions: Using paper, markers, or any other materials you have, create a poster or mini-booklet to share with the class. Your project should include:

• A summary of what you learned in each activity.

• One or two healthy heart tips for other families.

• Optional: Any photos, drawings, or other creative elements.

Submission

Bring your Family Heart Health Poster or Booklet to class to present what you learned with your classmates.

Appendix 2