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GPs should ignore QOF targets for hypertension, says former RCGP president

GPs should resist the ‘trend towards overtreatment’ in patients with mild hypertension and only prescribe antihypertensives for those at blood pressures of 160/100 mmHg or higher, argues former RCGP president Dr Iona Heath.

Dr Heath says that current QOF hypertension targets are unnecessary, at odds with guidelines and are leading to overtreatment.

Writing in a Viewpoint article in JAMA Internal Medicine, Dr Heath says: ‘In view of the mounting evidence of both waste and harm, it is well time that we returned to the higher threshold of 160/100 mmHg for the pharmaceutical treatment of hypertension in otherwise healthy people.’

Dr Heath highlights that a Cochrane review published last year found no reductions in mortality or morbidity from treating people with a systolic blood pressure of 140 to 159 mmHg and/or a diastolic blood pressure of 90–99 mmHg with antihypertensive drugs.

She also cites NICE guidance that recommends drug treatment in people with stage 1 hypertension (below 160/100 mmHg) only if they have other risk factors.

In this context, the QOF indicator HYP002, which awards points for the percentage of patients with hypertension with blood pressure no more than 150/90 mmHg, ‘drives the medicating of many people with stage 1 hypertension who have no comorbidity and who, according to the Cochrane review, will derive no benefit’, argues Dr Heath.

The indicator HYP003 introduced this year requires GPs to treat patients under 80 years of age at the even lower threshold of 140/90 mmHg.

Dr Heath writes: ‘In British general practice, enmeshed as it is in a web of guidelines that are underwritten by the payment-by-results targets of the QOF, it has become increasingly difficult to resist the trend towards overtreatment.’

JAMA Intern Med 2013; available online 13 May

Readers' comments (19)

  • I absolutely agree Iona and i'm sure you'll find alot of my colleagues thinking the same.We should also abandon prescribing statins for primary CVD prevention (unless its for familial hypercholesterolaemia)

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  • Totally agree but QoF puts food on my plate

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  • Mark Struthers

    QOF was designed for donkeys and GPs now live on carrots.

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  • Vinci Ho

    The controversy lies in Stage 1 hypertension as per NICE:
    (a)Stage 1 ABPM with an average > 135/85mmHg (this is considered equivocal to the clinic reading of 140/90)
    Stage 2 ABPM with an average > 150/95 mmHg(~ 160/100 mmHg in clinic).
    (b) Stage 1 without risk factors should be treated with non drug measures
    (c) Then problem is the target : 135/85mmHg by ABPM , 140/90mmHg in clinic for age <80 and 145/85 mmHg by ABPM and hence 150/90mmHg in clinic for over 80.
    (d) Problem is when you cannot achieve the target in Stage 1 with no risk factor despite all non drug measures . Would you wait until the readings deterioate until they reach stage 2 (150/95mmHg by HBPM , 160/100mmHg in clinic) before commencing drug therapy?Perhaps a different target is necessary for this sub group.

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  • Vinci Ho

    Alternatively , QOF should segregate stage 1 hypertension with no risk factor away from the rest ....

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  • Surely those with good conscience and following even legal guidelines of doing no harm, let alone moral and ethical practice would be well able to resist making money out of people who are mainly obviously ignorant of what is going on.it stinks and needs a better more rigorous condemnation than Iona Heath has managed.

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  • Who apart from Big Pharma is benefitting!!!!

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  • Puts food on your plate? well enjoy - it would choke many of us...

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  • Anonymous | 18 May 2013 8:18pm wrote:
    "Who apart from Big Pharma is benefitting!!!!"

    What about those politicians getting backhanders from Big Pharma

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  • Mark Struthers

    “The ‘quality framework’ that earns us a lot of money, I negotiated that. There happen to be fewer dead people as a result of that contract. About 8,500 people are not dead, where you would have expected them to die.”

    http://www.thejc.com/lifestyle/lifestyle-features/15213/he-won-gps-their-big-bucks

    That sort of crass nonsense is what has turned GPs into braying donkeys.

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