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GPs struggling with diabetes BP targets

BP and CVD risk were spotlighted at the American Diabetes Association conference – Cato Pedder reports

GPs are failing to use optimum doses of hypertension drugs and struggling to reach blood pressure targets in patients with type 2 diabetes, new research has found.

Clear protocols are needed to tackle 'conservative' GP attitudes to the management of blood pressure and the use of new drugs or hypertension targets will not be met, diabetes experts warned.

A UK study presented at this week's American Diabetes Association conference found that after three years of treatment, only 15 per cent of patients had reached the British Hypertension Society target of 130/80mmHg.

And despite strong evidence that using the ACE inhibitor ramipril at a 10mg/day dose in patients with diabetes reduces the risk of micro and macro-vascular disease, researchers found more than 70 per cent of patients were not prescribed that dose.

Under challenging diabetes targets in the new GMS contract, GPs can earn a maximum of 17 points if 55 per cent of patients with diabetes have a blood pressure of 145/85mmHg or less.

GPs have warned in the past that the target would be so difficult to reach that some practices might not even try. The new research found that after three years the average blood pressure had reduced to 155/85mmHg.

But the researchers, from King's Mill Hospital in Sutton-in-Ashfield, Nottinghamshire, conclude that 'innovative practices' such as the appointment of a nurse practitioner with prescribing authority could help in hitting targets.

And diabetes experts maintain that the quality framework target is achievable if patients are followed up and medications carefully titrated.

Dr Eugene Hughes, Isle of Wight GP and Primary Care Diabetes Europe member, said studies had consistently shown diabetes patients in the UK were 'inadequately' treated, perhaps because GPs were 'afraid' to use combination therapy, or used too low a dose. He said US doctors viewed British management of hypertension as the 'placebo arm'.

Dr Gillian Braunold, diabetes national service framework implementation group member and London GP, agreed that GPs tended to be conservative. She argued diabetes clinics and nurses created more protocol-led diabetes management and so better blood pressure control.

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