A Manchester GP and clinical lead for cardiovascular disease prevention in Greater Manchester is working with a collective of public sector leisure operators to help diffuse a potential time bomb unwittingly ticking away inside hundreds of thousands of people across the city-region.
Dr Aseem Mishra, CVD prevention lead for the Greater Manchester Integrated Care System (ICS), is collaborating with GM Active, a collective of 12 leisure and community organisations representing all 10 local authorities in Greater Manchester, to re-focus the lens on how hypertension – high blood pressure – is perceived, treated and managed.
Data from more than three million GP records compiled for the Greater Manchester ICS show approximately 420,000 known cases of hypertension in the city-region at the end of February 2025. However, Dr Mishra believes the total could be more than double that as hypertension doesn’t display symptoms except in extreme cases, while blood pressure testing in healthcare settings and at home is not prevalent enough.
“Hypertension is now the single biggest global risk factor for preventable deaths and disability adjusted lifespans,” says Dr Mishra. “It accounts for roughly half of all strokes and myocardial infarctions – heart attacks. Yet we still don’t know the prevalence of hypertension in an estimated 40% of the population. This is, unfortunately, not just a primary care or secondary care problem, but a whole system issue.”
Based in Wythenshawe, one of the multitudes of Greater Manchester areas with high levels of social deprivation, Dr Mishra cites health inequalities as a huge factor in the causes of CVD. This has prompted his collaboration with GM Active, whose GM Moving in Action strategy shares the desire to tackle health inequalities in the pursuit of getting more people physically active to improve community health and wellbeing.
Jon Keating, GM Active’s Head of Business Operations: “We have a coalition of 3,600 staff and 99 fitness and community facilities – Dr Mishra’s surgery is based in one of them at Wythenshawe Forum – and we believe we can play a significant role in offering physical activities that could help to combat hypertension.
“Aseem has set the scene that hypertension is a massive issue. We’ve spoken about the fact there isn’t an easy fix, but there are some quick wins in terms of getting people to raise their heart rate by being physically active.
“This piece of work is around how we can connect and work together to try and stop what has been described as a ticking timebomb with a holistic approach that’s not just about exercise and not just about taking tablets.”
Dr Mishra: “Healthcare doesn’t exist in a vacuum and there is often a complex interplay between healthcare, society, politics and economics. For me, the appreciation of the complexity and overlap between classically clinical pathways, wider social and demographic factors and particularly the fields of medicine and public health is the key to not just CVD prevention but for improving the whole of the healthcare system.”
Dr Mishra believes the perception of hypertension is misleading and needs to change to be more holistic: “We often we end up scaring people and causing anxiety when we talk about hypertension.
“It’s not a disease in the same way that you suffer pain, or you have cancer. It’s a risk factor; we know that people with higher blood pressure are more of at risk of heart attacks and strokes.
“But hypertension is getting into a grey area where it might be due to a sedentary lifestyle, it might be due to what you put in your mouth. It might be due to your genes, or in reality, a combination of all those.
“Rather than the standard high blood pressure messaging that you’re going to die of a heart attack type of stuff, we need to frame it in a positive way because there’s so much, we can do about it with treatment and with physical activity.
“People are siloed from the place they’re coming from. For example, charities like the British Heart Foundation are very medical, and lifestyle is just noted. Then there are other people who are all very non-medical and just talk about lifestyle and leave the medication stuff.
“So, I think it would be quite innovative if we were able to balance everything – create the holistic approach Jon has spoken about.”
The hypertension focus has developed from a cardiorespiratory training workshop organised between GM Active and the NHS Greater Manchester Neurorehabilitation and Integrated Stroke Delivery Network (GMNISDN).
It brought exercise professionals, physios, clinicians, and academics together under one roof to create better understanding and a stronger network to support for GM communities.
GMNISDN has since invited Mr Keating and GM Active colleague Michelle Childs, who chairs its health sub-committee, to address its 10th anniversary conference in Manchester in June, when they will be speaking about cardiorespiratory training to support CVD prevention and neurorehabilitation.
Before then, Mr Keating and Kate Harding, Strategic Lead, Health Inequalities, at GM Moving, will be speaking about the role of exercise at the GM Long-term Health Conditions operations and information exchange for clinical and locality leads next month.
