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GPs will struggle to score maximum quality points for controlling hypertension however hard they try, a new study suggests.

Researchers found that even after a detailed programme of audit and risk evaluation, a hard core of patients remained uncontrolled because of the lifestyle choices they made.

The findings were published as GPs predicted a last-minute rush to exception report patients who were resistant to treatment, to meet the maximum target of 70 per cent controlled. But they warned this would 'mask' true achievement levels.

The study of 52 Scottish practices found that auditing patients and ranking them by stroke risk improved the likelihood of controlling blood pressure by 70 per cent compared with standard care.

But even in this group, a third of patients failed to reach the study's threshold blood pressure of 160/90-mmHg and even more missed the tougher 150/90mmHg contract


Research leader Liz Mitchell, lecturer in primary care informatics at the Tayside Centre for General Practice, University of Dundee, said 'inadequate control' could not simply be blamed on a lack of GP effort. 'People make different choices. Patients forget to take their medicine. And there are other circumstances that might impact on control.'

Dr Robin Hollands, a GP in Cheltenham and quality and outcomes lead for Gloucestershire LMC, agreed GPs would struggle to meet targets. 'Exception reporting in hypertension will be high,' he said. 'I would hope it would be appropriate but it will mask achievement levels.'

The research, on records from 30,000 patients aged 65 to 79, was published in the British Journal of General Practice (February).

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