 The next item of business is a member's business debate on motion 5136 in the name of Marie Todd on May 2017, World Hypertension Month. The debate will be concluded without any questions being put, and I would ask those members who wish to speak in the debate to press the request-to-speak buttons now, please. I call on Marie Todd to open the debate up to seven minutes, please, Mr Todd. Thank you, Presiding Officer. Can I remind the chamber that I am a pharmacist registered with the General Pharmaceutical Council? I am also a member of the Health and Sport Committee and I am co-convener of the cross-party group on heart and stroke. It is because of my role in the cross-party group that I was keen to bring a debate about hypertension to this chamber to highlight the condition and also to highlight the great work of Professor Rian Tows and the British Heart Foundation in researching and tackling what is known as the silent killer. As the motion states, 30 per cent of adults in Scotland have high blood pressure and over 70,000 people in the Highlands and Islands, the area that I represent, are living with it. It is very common indeed. So why do we need to raise awareness about it? We need to raise awareness because hypertension is a crucial risk factor for cardiovascular disease and cardiovascular disease still causes more than a quarter of all deaths in Scotland in nearly 16,000 deaths a year. In particular, hypertension increases the risk of heart attack and stroke, and I will say a little bit more about that later. What is hypertension? Hypertension, or high blood pressure, is blood pressure that is consistently higher than the recommended level. We would talk about hypertension being readings that are consistently equal to or more than 140 over 90 millimetres of mercury. The target level is a wee bit lower if you have diabetes. Hypertension can damage your arteries, put extra strain on the heart, muscle and increase the risk of heart attack and stroke. It contributes to more than a fifth of all heart attacks and half of all strokes and increases the risks of conditions such as renal failure and dementia. Hypertension can be prevented. Even a small decrease in blood pressure, say two over four millimetres of mercury at the population level, could significantly reduce the prevalence of stroke and heart disease. Increasing public awareness is crucial, as is access to early detection and appropriate treatment. Let me tell you about the rule of halves and how it applies to high blood pressure. Only half of the patients with high blood pressure in a population have been diagnosed. Only half of those diagnosed have been treated, and only half of those treated have been adequately treated to normal blood pressure. One of the biggest problems for controlling high blood pressure is what we call compliance or concordance with treatment. Here is another half. As a pharmacist, I know well that only about half of the people who are prescribed medication take it as the prescriber intended. Given the background, I know that my community and primary care clinical pharmacists colleagues with their expertise in pharmaceutical care would be able to improve outcomes for folk with high hypertension. One of the particular challenges with high blood pressure is that folk do not feel ill. That is why it is called the silent killer. You do not know that you have it until you get your blood pressure checked. You only feel the effect of it after some damage to the target organs has been caused. In my experience, most people would rather not take medication, especially if it causes side effects. It is pretty hard to persevere with medication that can temporarily make you feel lousy when you felt perfectly well before you started it. Another problem is that people stop a reduced medication when their blood pressure falls to normal levels, but the condition does not go away. Despite there being very effective and cost effective drugs available, target blood pressure levels are often not reached. Thankfully, in Scotland, we have free prescriptions, so whilst there may be many barriers to taking medication as prescribed, cost is not one of them. I do not want to paint to bleak a picture because we have made incredible progress, particularly in the last 10 years, in reducing cardiovascular morbidity and mortality rates in Scotland. Given that so many of those illnesses in early death are preventable, of course we want to do more. I want to highlight particularly the impact of high blood pressure on stroke. You have recall that I said that it contributes to half of all strokes. Stroke is the most common cause of severe physical disability amongst adults. Half of all stroke survivors will have a disability. About 15,000 people in Scotland have a stroke every year, and up to 80 per cent of all strokes could be prevented. Preventing and correctly treating hypertension is far less costly and much safer for patients than interventions that may be needed once hypertension has led to damage or is not treated effectively. The cause of most hypertension is unknown. In a very small number of people, there is a specific cause for hypertension, for example kidney disease, but we do not know why someone gets it. Even though we do not know the cause, doing things such as maintaining a healthy weight, getting regular physical activity, cutting down alcohol intake, stopping smoking and reducing salt intake can help to maintain healthy blood pressure. The recommended daily allowance for salt intake is six grams, but in Scotland about two thirds of us eat more than that. We politicians need to make it easy for people to do the right thing. At the moment, energy dense, high-salt foods are easily available, affordable and widely accepted, making an unhealthy lifestyle the default option. It is cheap and easy to eat badly in Scotland, if only it could be cheap and easy to eat more fruit and veg. As I have said before, for many reasons, we need a programme of action that has at its core brave, bold, fiscal and regulatory and possibly legislative measures to change our food environment. Before I finish, I want to highlight some of the important work that the British Heart Foundation does in research and mention the work of Professor Rian Tows, who works at the research centre across at the University of Glasgow specialising in hypertension. Right here in Scotland, she and her team are unlocking some of the secrets of this condition and discovering some of the underlying molecular mechanisms such as the enzyme NOx5, a protein that is involved in the inflammatory process, which damages the blood vessels, narrowing them and therefore making blood pressure rise. Her research will not only increase our understanding but could potentially enable the development of new therapies. I want to finish by saying that World High Pretension Day was on 17 May this year, but the International Society of High Pretension is running May Measure Month. As part of that, the British Heart Foundation has been encouraging people to know their numbers. They are doing this by offering free blood pressure tests and type 2 diabetes tests at 375 Tesco stores across the UK. Blood pressure checks are also available in Superdrug. There is no excuse for not knowing your numbers this month. I want to finish by reminding everyone that this common condition can be diagnosed with a very simple test. It is easy to treat. I would encourage everyone to take the opportunity this month to know your numbers. I have speeches of up to four minutes, please. Donald Cameron, followed by Emma Harper. Thank you, Presiding Officer. I would like to begin by thanking Marie Todd for tabling the motion and for setting out the definition of hypertension and the difficulty, as she spoke, of establishing what causes it. She spoke about preventative measures, and as a fellow member of the health committee, she will know well that we have touched on the subject of preventative health on many occasions during the session of Parliament, both in the committee and in this chamber. It is clear that many of the conditions that are prevalent in Scotland are largely preventable through a combined approach of improving diet, increasing physical activity and reducing stress, and I will come back to that in a moment. However, as we know, this is easier said than done. As the motion notes, World Hypertension Month sets out to raise awareness of the condition that affects around 30 per cent of adults in Scotland. That is almost a third of Scottish adults—a very high proportion indeed—to suffer from one condition. The motion highlights the need to understand and improve knowledge of the causes of hypertension and to highlight the need for early intervention. I want to discuss three areas individually. I would like to begin by noting the need to raise awareness of the condition and the importance of people simply seeing their GP regularly, even if that is just for a check-up. As Chest, Heart and Stroke Scotland notes, it is difficult to know if you have high blood pressure, as are rarely any symptoms or visible afflictions, as Marie Todd pointed out. Hence why it is important to visit your GP or your local pharmacy, where, in many cases, a free blood pressure check can be provided. You can also buy a digital blood pressure monitor to take regular tests at home, and given the relative affordability of such kits, it is certainly a viable option for many people, although clearly not everyone. All that said, I would like to highlight in particular the option of using a pharmacy, particularly as we try to move care further into the community and the role of pharmacists is enhanced. It is vitally important that, as people begin to use less acute services and more community-based services, we all do as much as possible to promote the services that are offered both in general practice and without it, so we are able to strike the right balance. As I stated earlier, the motion also talks about the need to understand the causes of hypertension. We know that, in some cases, be it genetic or just simply growing old, preventative options are fairly limited. However, there are a variety of causes that can be dealt with through lifestyle changes. A third of adults in Scotland are obese, as we all know, and 37 per cent of people do not meet the recommended level of physical activity. Many of those issues can often lead to high blood pressure, which can then exacerbate and result in a variety of conditions that are all too common in Scotland in that Marie Todd spoke of. High pretension can lead to stroke, for example, with around 26,000 hospitals visits and 4,300 deaths each year. Heart attacks are another end result, and this eventuality results in 25,000 hospital visits every year. Those and other conditions place a heavy strain on the NHS, and it is therefore incumbent upon us all to identify solutions so that hypertension can be reduced and we can tackle the resulting conditions. Actions speak louder than words, and my colleague Brian Whittle will tell us about his ideas on a healthy lifestyle strategy. He has already presented a document that is in no means finalised nor partisan. It is to produce a kickstart to a much-needed debate in this area around early intervention and prevention. Deputy Presiding Officer, I would like to close by noting that we need to have more debates on issues such as world type attention months. It is important that we raise awareness of those conditions, but fundamentally it is vital that we continue to debate and discuss the much bigger picture, which is the need for early interventions and for policies that can achieve the ultimate aim to cure Scotland of the many ills that continue to burden our nation. I call Emma Harper to be followed by Anas Sarwar. I thank my colleague Marie Todd for securing the member's debate. Marie's Todd's motion states that the month of May is hypertension awareness month, and although May 17 is the actual day, by having this debate today and raising awareness throughout the month, we can raise awareness of hypertension, which is more commonly referred to as high blood pressure. I support Marie's motion and I would like to remind members of my interests. I am currently a non-practicing nurse and I am a member of the chest, heart and stroke cross-party group also. High blood pressure rarely has noticeable symptoms. If it is untreated, it increases the risk of more serious problems such as cardiovascular problems, heart attacks and cerebral vascular events or strokes. The only way to find out if your blood pressure is high is to have it checked regularly. A health professional such as a doctor, nurse or healthcare support worker can check your blood pressure easily while assessing other vital signs such as pulse respiration rate and temperature. Many pharmacies across Scotland also have the ability to check your blood pressure, and health road shows are also a way to encourage public engagement and screening to find out if your pressure is within normal limits. There are various causes of high blood pressure. Being overweight can be a contributing factor. Too much dietary salt, as has been mentioned, alcohol and caffeine also increase the risk of high blood pressure and, as does smoking and lack of exercise. Even lack of sleep can be a contributing factor. It looks like I may have five out of those seven risk factors, but I will not tell you which ones. Once diagnosed, the treatment involves pharmacological and non-pharmacological treatments. Lifestyle changes with help to achieve those lifestyle changes are likely to be the first encouraged to address the factors that I have spoken about already, such as smoking and diet. Some people with high blood pressure may also need to take one or more medicines to stop their blood pressure getting too high. That means senior GP or advanced nurse practitioner and monitoring the effects of the medications that are prescribed. Studies have shown that many people do not take their anti-hypertensive medication regularly, or at all ones that are prescribed, so do not omit your medications that are prescribed. The health consequences of prolonged high blood pressure can be catastrophic, such as cardiovascular problems of angina to heart attack, requiring invasive procedures such as stent placement or coronary artery bypass. The tiny wee blood vessels in your eyes can be damaged, leading to retinal disease causing blindness. Eye tests are free in Scotland, and any optometrist that provides NHS service will provide your eye tests for free. That helps with early screening and direct referral, and faster access to treatment, and it can reduce the burden of GP's time. The tiny wee vessels in the kidneys do not cope with raised pressure either and can result in compromisability of the kidneys to dialyse or filter waste products efficiently. Kidney damage leads to chronic kidney problems and electrolyte imbalance. All that contributes to further health problems, potentially leading to lifelong dialysis. The most high-profile consequences of high blood pressure is stroke, and increased public awareness of that is very welcome. Fantastic public information campaigns such as Stroke Act Fast, FAST, have been very successful in highlighting symptoms and saving lives. Fast means that stroke is recognised and dealt with quickly, and patients are sent to dedicated stroke centres instead of waiting for assessment in a non-specialist place. The fast acronym is useful and worth outlining again today. F stands for face, has it fallen on one side, arms can be raised equally, and speech is slurred, and time, if you notice any of those signs, is called 999 immediately. I would like to pay tribute to the four stroke liaison nurses in NHS Dumfries and Galloway, especially Christine Cartner, because I trained with her more than 30 years ago. The message is that hypertension can be detected, checked, treated and controlled, and I urge everyone to avoid potential more complex health problems by having your blood pressure checked regularly, making lifestyle changes where necessary, and do not omit taking your meds. As I rise to speak, I am sure that my thoughts and thoughts of everyone around the chamber will continue to be with our friends in Manchester, particularly as we see the continued tragic stories that have been revealed and the victims themselves being named. Just on that as a link to the debate, I want to put on record what Marie Todd did with our thanks to all our amazing NHS staff, whether that be our first responders or indeed our nurses, pharmacists, our GPs and all the rest who all year round care for our fellow citizens. I thank Marie Todd for bringing the debate forward today. What I like best about the debates that he gives us is all the opportunity to do some research on some medical conditions that we ourselves might have and then to come and articulate our own thoughts and opinions on those conditions in the chamber. I hope that I will attempt to raise awareness of those important issues and encourage our fellow citizens to access treatments and healthcare professionals to try to get appropriate diagnoses. I should say that, from listening to Emma Harper's contribution, I do not think that she is alone in meeting many of the risk factors in terms of the risk of hypertension. That is probably something that reflects the vast majority of people in the chamber. I think that we probably have a higher incidence rate of hypertension and high blood pressure than the average population. I am sure that our whips have nothing to do with it at all. As my whip next door to me says here and here, I want to put on record my thanks to Professor Ryan Tooes, who is also being mentioned by Marie Todd, but also to the British Heart Foundation, who do a stellar job in terms of bringing forward those matters to the chamber. Indeed, lobbying all sides of the chamber around the important issues affecting all things the heart. Professor Ryan Tooes, who is based at the University of Glasgow, originated from Canada and leads the research project at Glasgow, the Cardiovascular Research Centre. Because of the generous support of the British Heart Foundation, with a combined grant of £2.75 million, is able to do that fantastic work that Marie Todd set out around the NOX5 enzyme that can be a leading treatment and prevention of hypertension, not just in Scotland but can be a leading right around the world. I want to put on record our thanks to Professor Toes and also to the British Heart Foundation. We have already heard about the risks of high blood pressure and the conditions that it can lead to, whether that be heart disease, heart attacks, strokes, heart failure, kidney disease and so much else. We also need to, in terms of a public health perspective, get the argument across to the wider public. The family history of high blood pressure, something that I know is a regular occurrence in my own household. Individuals' ethnicity can lead to a higher chance of having high blood pressure, a high amount of salt in their food, a lack of exercise being overweight or obese, drinking large amounts of alcohol, smoking or, as has been said before, long-term sleep deprivation, as well. I suppose that the plea to people right across Scotland would be to recognise the symptoms, secondly, access your health centres, whether that be your GP practice and your pharmacy and have your blood pressure checked, look at your behavioural lifestyle in terms of your diet and your salt intake, how active you are, how much alcohol you consume, whether you smoke your caffeine intake and get in the right level of sleep. All the things that I have promised and resolved to take more interest in in my own life from this day on. In closing, I want to thank Marie Todd again. I thank Professor Toys for all her hard work. I thank the British Heart Foundation, but above all else, I thank my wife for keeping my blood pressure vulnerable. I would be interested in her perspective on that, I have to say. Stuart Stevenson to be followed by Brian Whittle. Thank you, Presiding Officer, and let me, like others, thank Marie Todd for the opportunity to discuss something that probably is of interest to every one of us personally, either as an individual or as some member of the family. I am not a regular reader of hypertension news, but on February 2017, I read of the objective of screening 25 million people's blood pressure in May this year. I can advise the chamber that I have made my little contribution with a very helpful co-operation of my MSP colleague Emma Harper, who had her sphigmonometer and stethoscope at the ready earlier today and took my blood pressure. It was not good news, but I had just come up the stairs and I hadn't sat down and done my calming down. So 158 over 70, okay on the diastolic, a wee bit high on the systolic, was rather higher than the previous time I had it when it was 130 over 75, which is kind of where I'd like to be. But I'm going to go away and think about this salt business. I might even give up drinking for a couple of days, because I think for each of us there are things that we can do. But the publication that I referred to, hypertension news, a lot of quite interesting articles in it. There's one article, for example, about a German lady, 54 years old, Slim, quite fit, but her blood pressure is regularly over 300 systolic and a diastolic in the 170-180 range. She's quite healthy, but the drugs have stopped working for her. Therefore, it's one illustration among very many that each hypertensive person is likely to be quite individual and require individual attention. The publication also talked about a lot of work that's been done to try and identify DNA triggers that might create a predisposition to or which, by resetting the DNA one might address, it's fair to say that with almost no success whatsoever, it suggests that only one milligram, which is but nothing, is beyond clinical measurement accuracy, is attributable to DNA. We don't know why it happened. For something that affects the number of people that it does, that's quite worrying. I think that the efforts of the British Heart Foundation and others to continue research into conditions that affect the heart adversely is something that we should continue to support, because from the reading that I've done at least today, I know that we know much less than I thought we knew, and that's a bit concerning. I must say that, as somebody who's hobby's family research, I've read in my own family tree over 2,000 death certificates, and I'm relatively pleased to say that dying from heart failure is not a major one, although strokes are quite common in that, so I'm going to weigh and have a think about that. As a private pilot, of course, I have an annual medical report, which includes testing my blood pressure, testing my urinacy of diabetic, testing my hearing, testing my eyesight and an ECG. In 20, nearly 30 years, I've only had a single-act topic heartbeat in my ECG, which is good news, but we've seen a steady growth in my blood pressure, and that won't be unusual. I've just closed by saying diet, and I'm going to think about my diet, maybe salt in particular. The association diet and hypertension is quite well known, and the Mediterranean diet is relatively well known to be one that is not associated with hypertension. The really bad news is this week that because of weather conditions, there's an olive oil shortage, so I encourage colleagues that there is a good substitute. It's Scottish extra virgin rapeseed oil, which you can get in the north-east of Scotland in my constituency, so don't worry, we've got the solution in the north-east, even if the Italians are letting the side down by not producing enough olive oil. This is a fascinating subject. I'm sure it will run and run. I'm going to be interested to hear what Mr Whittle is going to say in particular, because I know that he's very interested in the subject, Presiding Officer. Follow that. Brian Whittle, who's followed by David Torrance. Thank you, Deputy Presiding Officer. I will also be interested in what Mr Whittle's got to say, because he hasn't written a speech, so he's gone by swinging it. I thank Marie Todd for bringing this subject to the chamber. It is something that I am extremely interested in. In terms of hypertension month, it's probably very pertinent to this chamber, because the last month has probably raised more blood pressure figures, as has been said, than average. The causes of high blood pressure are something that has been mentioned quite a lot, but high blood pressure itself is really about pushing the blood around the system and the heart having to work much harder to do so. That is dangerous, of course, because it contributes to the hardening of the arteries. It also continues to stroke the kidney disease and the development of heart failure, as has previously been stated. The causes, again, have been talked about. The one that I'm really interested in is age, and I'm wondering what that means as I do my journey through my ffifties. Family heart is the history of high blood pressure. I know, Mr Stevenson, I am buoyed by the fact that you are still with us. What is interesting, as well, is that being African or Caribbean gives you a higher level of incidence of that. The real meat of it for me is high amounts of salt in your food, as Mr Stevenson has said, and a lack of exercise. I'm going to talk about that a lot. Being overweight and obese is regularly drinking large amounts of alcohol, smoking and sleep deprivation. Prevention sits within healthy diet, limiting your alcohol intake for at least two days. Mr Stevenson, losing weight and cutting down your caffeine, which is one of my big problems—getting active and stopping smoking. Lifestyle modification is something that really helps with hypertension. Having a fall-back position when you are feeling stress is something that we are all aware of, especially at this time. My fall-back position has always been to pull my kit on and go for a trot around the woods, preferably with my earphones on and some nice soothing music, such as ACDC or something like that, or perhaps plugging in my guitar and smashing out some ACDC tracks is really helpful as well. However, if I want to put my thoughts in order, I tend not to take my music with me and run and try to think the problem through, which I'm trying to do more now than I used to in this chamber. Unfortunately, I put my thoughts in order, but my memory is not very good, so I immediately forget when I go back into the house. I have a fall-back position when I have stress-related or a bit of pressure, and I often wonder what happens to those people who do not have a fall-back position, and that tension is allowed to build. That is something that Donald Cameron alluded to, which is where I have focused most of my time in this chamber. I tried to produce a document earlier on this year that was very apolitical, apart from the front cover that said that there was no mention of any politics in it after that. Some of the things that I would really like to look at, as has been said before, is how we make fresh fruit and vegetables more wildly available across all demographics and how we encourage those fruit vegetables to be taken. Physical education is obviously a huge one for me. Physical education is about giving people the tools for life to understand what physical activity does for the quality of life, and that is certainly an educational intervention that we are looking at there. Echoing the RCPE's physical activity should be embodied into primary care, secondary care, social care and health education, as well as into health and social care workforce and workplace. The highest nutritional value of meals should be the primary objective of food procurement policy, because we have an issue in Scotland around our health, and the preventive agenda is something that I am keen on. I will stop there and say that I could go on for a long time in the debate to thank Moretor for bringing it to the chamber. I was beginning to realise that, Mr Moretor. I call David Torrance to be followed by the last of the open speeches, which is Colin Smith. Thank you, Presiding Officer. I played my part earlier this month as well when I was giving a monitor away for a day. I handed it in the next day, and the doctor phones me and said that he peaked at 240 over 190. I went, oh, right. He said, can you tell me where you were at half past seven that night? I said, is it my branch meeting? So there is the clue, Presiding Officer, do not go to your branch meeting and your blood pressure will be all right. I would like to thank Moretor for bringing this motion to Parliament today to recognise world-type attention month. That raises awareness for those suffering from stroke and heart condition. It is also crucial to recognise not only those who are affected by high blood pressure, but those who remain undiagnosed by a silent condition. The international society for hypertension presents an ambition goal through our blood pressure awareness campaign, May measurement month, to screen 25 million people who have not had their blood pressure measured for over a year. That means screening an average of 100 people in 100 sites in 100 countries every day throughout the month of May. This is an ambitious yet achievable goal that can be reached by working together, but we can make a difference to the biggest single contributor to global death. 60 million people in the UK have high blood pressure, one-third of those people do not know they have it. As high blood pressure really has any symptoms, those people are also three times more likely to develop heart disease and stroke. High blood pressure is entirely preventable on one of the most preventable conditions, but still remains one of the leading causes of death in the UK. We face complex challenges to prevent and control hypertension both globally and nationally, and I hope that the data collected during the world hypertension month can be used to support research on a national, regional and global level. There is only one way to identify blood pressure by having a GP or other health professional measure it. That is why we need to educate people and increase awareness. High hypertension risk varies with income. Those with lower socioeconomic status are much more likely to develop heart conditions than those who are welfare and generally better educated. The risk persists even with the long-term progress in addressing main risk factors such as smoking and high cholesterol. That is why low socioeconomic status needs to be regarded as a heart disease risk factor that is owned by a medical community as well as a political community, as those effects are cumulative. Among women especially, it has been proven that levels of high blood pressure increase as income decreases. According to the British Heart Foundation, women are less likely to seek medical attention and treatment despite the warning signs. The risk of heart disease and menopause are correlated, and risk continues to increase with age. Women's hormones may provide some protection from heart disease, but post-menopause, the risk rises. It is crucial for women to recognise the symptoms. Heart disease kills more than twice as many women as breast cancer every year, yet remains to be perceived by society as a man's disease. The Women's Hypertension Research Network was established to encourage, support and inspire women in science and medicine in the field of hypertension and related heart conditions, and creates avenues for women to communicate, collaborate and educate. In 2016, in Scotland, 30 per cent of those tested had high blood pressure. That number is higher than five, with 39 per cent of those tested having high blood pressure. Keep well clinics, a Scotland-wide programme, seek to reduce the risk of ill health, and there are several clinics across Fife where community nurses can measure blood pressure. Despite the tremendous services provided by the NHS, heart disease can place a massive emotional burden and create serious financial stress. In Scotland, Chess Heart Restokes Scotland and Citizens Advice Bureau have appointed three benefit advisers to help to give advice and information about social security benefits to people in need of assistance. In conclusion, I applaud the efforts by those involved in the World Hypertension month to improve the populations over our health. We need to prevent people from developing high blood pressure in the first place by encouraging better diet, exercise and reducing stress. I hope that that initiative has brought together communities, healthcare professions, health systems, non-profit organisations, charities and private sector partners to improve care and empower the Scottish population to make the hearty healthy choices. The last of the open speakers is Colin Smyth. I echo other members in thanking Mary Todd for tabling the motion and allowing us the opportunity to play our part in raising awareness during the World Hypertension month, and in particular stressing the dangers of the silent killer. I also thank the British Heart Foundation for their excellent briefing, which was very helpful in preparing for today's debate, but I also echo all the work that they do in leading the fight against heart disease and echo the comments of others on paying tribute to our healthcare workforce today of all days. As has been mentioned, high hypertension or high blood pressure, as it is more commonly known, affects almost 30 per cent of the adult population in Scotland. It is a crucial risk factor in cardiovascular disease that causes more than a quarter of deaths in Scotland each year. In fact, it is estimated that 670,000 people are currently living with cardiovascular disease in Scotland at a cost to a health service of £800 million a year. As well as being at a major cause of cardiovascular disease, high hypertension also has a significant impact on the risk of developing other serious conditions. It contributes to more than a fifth of all heart attacks and half of all strokes and increases the risk of someone developing conditions such as renal failure and dementia. However, despite the huge risks associated with hypertension, around 7 million people across the UK are currently living with undiagnosed high blood pressure. Of the 30 per cent of adults in Scotland living with hypertension, half are not receiving any treatment. Of those who are diagnosed, one in six are not treated effectively enough to reduce their blood pressure to target levels. Not surprisingly, the British Heart Foundation recommended that everyone over 40 should have their blood pressure check, which, looking around, probably means most of us in the chamber today. There have been Government-backed campaigns to encourage people to have their blood pressure check, but many health professionals rightly argue that those can often succeed in encouraging mainly the worried well to have checks rather than those most at risk of developing cardiovascular disease, particularly those who live in the most deprived communities and are victims of the inverse care law. Now more than ever, we need creative solutions to the significant health challenge to ensure that those most at risk receive the diagnosis and treatment that they need. Our GPs will remain the first port of call for many people seeking healthcare and health advice, but we all know that our GPs in almost every area of the country are stretched beyond capacity. We not only need to build the capacity within our GPs surgeries and make sure that we tackle the chronic shortage of doctors, but we also consider other services to ensure that everyone is made aware of the importance of checking their own blood pressure or having that blood pressure check. Extending blood pressure checks from the GPs surgery into more community pharmacies and more community outreach services could go some way to reaching those most at risk of hypertension. I asked the minister when summon up today to say whether that is an approach that the Government is encouraging and what other measures the Government intends to take to overcome the current barriers to the diagnosis of hypertension. Preventing and correctly treating hypertension is far less costly than interventions that may be needed when hypertension is not diagnosed or treated effectively. Maintaining a healthy weight, getting regular physical exercise, cutting down alcohol intake and reducing salt on a diet can all go some way towards a healthy blood pressure. However, as we know today, as Donald Cameron highlighted, two thirds of adults in Scotland are now overweight, with more than a fifth of children in Scotland at risk of being overweight or obese by the time they reach school. Determined measures are therefore needed, so I had once again urged the Government that, when the new obesity strategy is published later this year, it includes firm action on unhealthy supermarket promotions and restrictions on multi-buy discounts on unhealthy food so that the healthy choice becomes a cheaper option for Scotland's families. Reducing a calorie intake alone is not enough to mitigate the risk of hypertension. Stewart Stevenson and Brian Whittle both highlighted that two thirds of adults in Scotland still eat too much salt despite a reduction in recent years, so cutting the amount of salt on a diet as well as increasing physical exercise are also key measures to maintaining a healthy blood pressure. In concluding, I want to once again thank Mary Todd for the opportunity to debate this important issue, and maybe given the demographics of most of the chamber today, including myself, reiterate once again the importance of getting our blood pressure checked. As Mary Todd said, it is important that we know our numbers. If those numbers are as high as Stewart Stevenson's and David Torrance's, we also need to make sure that we get the help and support that we need. I now call on young Aileen Campbell to respond to the debate. I was going to address that later on in my remarks, but for the records and for Colin Smyth's information, I think myself, Anna Sarwar, Monica Lennon—anyone else? Tom? Sorry, I do not want to offend anyone else. We are all under 40, so maybe it is that lack of sleep that will suffer from the fact that you have misunderstood those sleep lines for age lines. Thank you. I point it forward. But again, more seriously, and firstly, before I go into the debate on hypertension, I want others, and Anna Sarwar and others, to put on record and pay tribute to all health and social care professionals doing so much to help those devastated by the brutal effects of what happened in Manchester last night. In our thoughts and prayers remain with everyone in Manchester and our gratitude to the brave staff for doing what they can to help others. Returning now back to the debate on hypertension, I am also pleased to take this opportunity to raise awareness of hypertension and the work in preventing and treating it by the Scottish Government, NHS Scotland and others. Of course, I thank Marie Todd for bringing in the debate tonight to the chamber. I would specifically like to thank, when I say others, the British Heart Foundation, who is an active contributor to our national advisory committee for heart disease and a partner in our out-of-hospital cardiac arrest strategy. The British Heart Foundation of course does so much in terms of research and recently I had the real pleasure of visiting the Heart Foundation's Centre of Research Excellence at the University of Edinburgh in Little France earlier this year. I also again recognise the work of Professor Rianne Toys and the Institute of Cardiovascular and Medical Sciences, which is eminent in the fields of hypertension. I will no doubt continue to inform our approach to this condition. As others have reflected on what hypertension is and its impact on people, it often has no symptoms but is a risk for heart disease and stroke, major causes of death in Scotland, which could be prevented. That has been a crucial point throughout Marie Todd's opening remarks and also of Donald Cameron's and others. That devastating knowledge that so many of Scotland's poor health outcomes can be avoided, costly in terms of the public per purse, but also what it means for someone who is suffering. Overall, 28 per cent of people in Scotland have high blood pressure and we know that prevalence increases sharply with age. Almost two-thirds of people over 75 years have high blood pressure. It is hardening that there was a significant decrease in high hypertension in the Scottish population from 33 to 28 per cent from 2011 to 13. That has remained level since, but we continue to take actions that will contribute to further lowering the incidence rates. In Scotland there is a high prevalence of the risk factors for high hypertension. I will talk some more about our action to tackle it, the lifestyle modification that Brian Whittle and others have already mentioned in their remarks. I want to highlight our approach in diagnosing and managing hypertension in primary care, because we expect GPs to consider routinely checking the blood pressure of people without symptoms or existing conditions aged over 40. In addition, GPs with their staff will check blood pressures when they see patients with a wide variety of symptoms. That can be a part of monitoring of people with long-term conditions, such as high hypertension, diabetes and those who have experienced a stroke. We are also raising awareness of hypertension so that people know what they can do. NHS Inform has information on prevention symptoms, diagnosis, treatment and complications and who to ask for help. For NHS Scotland, clinical staff, heart, e and stars, both part funded by Scottish Government, offer e-learning resources in cardiovascular disease risk management, including hypertension. It is our population health improvement actions on alcohol, on diet, physical activity and tobacco use that will also contribute to reducing the incidence of high blood pressure. Prevention is a key part of not just our approach around hypertension, but it is also a key part in the plan of our health and social care delivery plan, our national clinical strategy and the realistic medicine approach that is outlined by our chief medical officer. To give Colin Smyth some comfort around what he was looking for, around exploring all avenues to identify high blood pressure, one example is the need for annual checks for our diabetes, which we have promoted through our community pharmacy campaign, the nine checks for that, which includes blood pressure. Again, that is using all avenues in all ways in which we can promote good positive health outcomes, but also making sure that we have tangible things that community pharmacists and other health professionals can do to help to increase good health. Limiting alcohol consumption can also lower the risk of developing hypertension. Our alcohol strategies framework for action has a package of over 40 measures to reduce consumption, encourage more positive attitudes and choices and improve treatment and support services. Our refreshed alcohol strategy will be introduced in summer this year and focus on embedding and building on that framework. We continue to believe that a minimum unit price for alcohol as part of a concerted range of measures is the most effective and efficient way to tackle alcohol misuse in Scotland. Minimum pricing will target heavy drinkers as they tend to drink the cheap, high-strength alcohol that will be most affected by the policy. We are continuing to be disappointed by the delay to minimum unit pricing but remain committed to it and will continue to defend the policy at the Supreme Court. We have given an undertaking not to implement minimum unit pricing until the judicial process is fully determined. If the Supreme Court finds in our favour, we will seek to implement that measure as soon as possible. We also know that a poor diet also increases the risk of high blood pressure and investing in a range of programmes to improve diets in Scotland. We are promoting healthy reading as a simple affordable choice for all in Scotland through our Eat Better, Feel Better social marketing campaign. We fund the healthy living awards and healthy living programmes, supporting caterers and retailers to make healthy choices more easily available through the provision of guidance, support and training. Of course, we will be bringing forward our diet and obesity strategy and learning the lessons of those bold measures that we have taken around alcohol and smoking where it has made a real impact and made the impact that we desire. Those were points raised by Marie Todd and Colin Smyth. It is not just what we eat and drink that can help to reduce the risk of developing hypertension. What we do makes a real difference as well. Being active has many health benefits and can reduce the risk of developing hypertension on other chronic additions. A fifth of adults in Scotland are inactive, but addressing that requires lots of action by many of our partners. We will continue to put effort and work into that and to do something in all settings, as set out in the Toronto Charter for Physical Activity. Of course, not smoking, in addition to the many other health benefits, can help to reduce the risk of developing hypertension and other illnesses. We will continue our efforts to reduce the number of people who smoke. We welcome the contribution of those seeking to raise awareness of hypertension. We will continue to remain committed to ensuring that the NHS builds on its commendable achievements in detecting and treating people with hypertension and learn where we can do more, including raising awareness as others have done in this debate. Today's debate has been informative. We have raised collectively as a Parliament awareness of hypertension and should continue to work across political lines in order to do so. We have also learned that Stuart Stevenson likes to read death certificates. We have also learned that Brian Whittle can often be found running in the woods listening to ACDC. Of course, David Torrance continues to avoid branch meetings. We have learned an awful lot today, but more seriously alongside the work that I have outlined around our preventative measures that we are taking to ensure that people can lead healthier lifestyles, we will continue to pursue action for prevention to reduce the risk of people in Scotland developing hypertension in the future, contributing to better outcomes, quality of life and ultimately the healthier Scotland that I know that we all wish to see regardless of the political party that we are here to represent. I again put on record my thanks to Mary Todd and others for contributing fully to this important debate. Thank you. I close this meeting.