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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)

  • without the qof money the practice would close.simple.I guess many GPs are in a similar position
    so don't acuse me of being greedy chasing targets without any understanding.

    I take the third way. you code "patient on maximal treatment for hypertension" when I think further treatment is not in the patients in terest. the practice still gets its funding and the patient is excepted from the marker.all quite legally and properly

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  • re 'the third way' using disingenuous methods and weasel words is not 'proper'....it is dishonest

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  • Mark Struthers

    The QOF incentivises deceitfulness and dishonesty. If you imagine GPs don't falsify BP recordings then you lack any imagination. It’s time to get rid of the QOF and all those who deployed it.

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  • You're missing the point blaming big pharma - this is an almost totally genericised area of prescribing, nothing there for big pharma.

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  • Let common sense prevail

    I welcome Dr Heath's opinion, which shows strong leadership. We have to question how the QOF has evolved to contain parameters which we, as a profession, almost universally feel are inappropriate. We need to look at who is designing QOF and how they make their decisions, many of which are not in the interests of patients or their GP's.

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  • To quote my old professor, probably referring to the MRC study that brought in treatment of hypertension of 160/100
    "A significant reduction in bugger all, is still bugger all"

    The short term benefits of treating even 160/100 in the under 65s is small ... 800years of treatment to prevent 1stroke?

    We need to risk assess, and then treat to a target of risk.
    And actually that means statins for primary prevention. They give bigger benefit for less risk and cost.

    And we need to stop treating hypertension as a "disease" ... It isn't.

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  • One day we might get some common sense written?!
    When a Cochrane review makes such a simple and unequivocal statement, then how can you justify treating huge numbers of people with pharmaceuticals which yield no positive benefits and yet have several negative effects.
    Come on, do your research and follow Dr Heath's lead. She's right you know!

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  • Mark Struthers

    Iona Heath said,

    "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."

    And who benefits from this overtreatment? Pharma, of course ... and carrot chasing donkeys.

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  • In spite of QOF, LES, DES and all the rest of the stuff, our take home pay per consultation varies between £2.50 to £ 3.50. It is not a King.s ransom. We demean ourselves with this rubbish, but the alternative is Private medicine.

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