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Letter of the week: Target culture is becoming dangerously absurd

Now I read the target culture is about to get sillier, with new lower blood pressure targets for chronic kidney disease (News, 24 October).

A target is fairly meaningless – simply the last blood pressure reading before 31 March of that QOF year. Blood pressure can vary by 30% over a 24-hour period, so when I measure it, one variable is pure chance.

I get patients with CKD who I think are to target but the nephrologists tell me sometimes that my treatment is causing reduced renal perfusion, as the randomly measured BP is on the low end of the range at that random point in time.

If we go into overdrive to get our patients to new CKD targets, how much damage will be caused by reduced renal perfusion and hypotensive falls?

I can think of a number of hospital admissions in the past year caused by falls, confusion, hyponatraemia and hypokalaemia induced by blood pressure targets. I'm sure many other GPs can too.

Targets should be based on averages, not random ‘last readings' and overall benefit should be on all-cause morbidity, rather than simply renal effects as seen by specialists who only get a very partial picture.

From Dr Bernie Bedford, Southampton

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