GPs ignore NHS policy and chase JBS2 targets
By Lilian Anekwe
UK doctors also among first in the world to move away from diuretic use
A majority of GPs are chasing aggressive cholesterol targets for secondary prevention against explicit Department of Health advice not to go beyond targets set in the contract.
GPs in the UK are also among the first in the world to move away en masse from use of diuretics as first-line treatment for hypertension.
A Pulse survey of 400 GPs, conducted with doctors' mobile communications firm Pearl Medical, found 54% were now aiming for lipid targets of 4mmol/l total cholesterol and 2mmol/l LDL-cholesterol – as recommended in the controversial JBS2 guidelines.
Only 38% said they aimed for the quality framework targets of 5 and 3, despite guidance issued in November last year by Dr Roger Boyle, the Government's heart tsar, which instructed GPs to dismiss the JBS2 guidance as a 'misconception'.
'National policy accepts 5mmol/l for total cholesterol and 3mmol/l for LDL cholesterol as targets for therapy, as per the national service framework for CHD,' the guidance reiterated.
Professor Peter Sever, professor of clinical pharmacology at Imperial College London, said he was impressed by how quickly GPs had responded to the evidence.
'It's entirely evidence-based to set targets at 4 and 2. If anything, it surprises me the shift in thinking has happened so quickly.'
But Dr Neal Maskrey, director of evidence-based therapeutics at the National Prescribing Centre, warned: 'The national director for heart disease and stroke has made it very clear the NHS target is 5 and 3.
'After a full review, analysis and expert debate, SIGN has also recently recommended the same target.'
The survey also found an even split between GPs using diuretics (32.9%), calcium channel blockers (33.2%) and ACE inhibitors (33.2%) as first-line anti-hypertensives for white patients over the age of 55.
Professor Sever, who co-chaired the ASCOT trial finding benefits for calcium channel blockers and ACE inhibitors, said: 'We are more advanced than other countries when it comes to this and I think in time we will see an even greater shift towards calcium channel blockers.
'But Dr John Ashcroft, CHD lead for Erewash PCT and a GP in Ilkeston, Derbyshire, said: 'I don't think GPs should be unduly influenced by [ASCOT] because diuretics are good drugs.'