Statinopril all denture cleaners? At least it’ll save us work
I’ve decided to spring clean my columns and blogs. Which means I’ll be sweeping away words like ‘new’, ‘contract’, ‘primary’, ‘care’ or ‘networks’, as we’re thoroughly sick of them.
So I’m grateful to NICE – and that’s not a phrase I use very often – for its new draft hypertension guidance. And I’m even more grateful that it hasn’t lowered the thresholds for diagnosing hypertension. Phew. As we were, then.
Well, not quite. Because while the diagnostic threshold hasn’t been slashed, the intervention one has. The old 20% CVD risk cut-off is now officially 10%. So although that chap with stage 1 hypertension might feel like the same person he was yesterday, he isn’t; today he becomes a pill-popping patient.
Worse still, when was the last time any punter middle aged or above had an office BP reading of <140/90 and an ambulatory day average of <135/85? Precisely. Never. In which case, anyone over 65 (or 59 in men) has a risk greater than 10%, even if their other parameters would shame a vegan Trappist monk with 120-year-old parents. Try it on QRisk if you don’t believe me.
We’ve been here before, of course. Run through that last para again, replacing ‘BP’ with ‘lipids’ and you’ll find those same age groups should be offered statins.
So anyone over 65 is now at risk, even if their other parameters would shame a Trappist vegan
In other words, we’re obliged to statinise or antihypertensify, and probably both, a huge proportion of the ‘well’ population. And the most annoying thing, of course – apart from the workload, the cost, the repeated explanations, the anxiety generated, the mind-numbing drudgery, the iatrogenesis, the endless cycle of follow-up and monitoring, the chasing up of defaulters, the interminable, confused consultations about side-effects that aren’t really, and the pervasive and unhealthy over-valuing of risk factors that for each individual may well be pretty irrelevant – is that this new guidance came just after the deadline for Pulse’s last issue about overdiagnosis. Thoughtless.
Look, if they do want the masses medicated, why not revisit the polypill idea and be done with it? Or even better, do for the silver-haired what public health does for the milk-toothed: instead of fluoridating tapwater, statinopril all denture cleaners. Just leave us GPs out of it.
After all, whenever guidance like this appears, it reminds me that we don’t know what we’re doing. Or rather, we know what we’re doing, but we don’t know why we’re doing it. Thanks to guidance like this, people may not die ‘prematurely’ of a CVA or MI, but after enduring bonus life years full of dementia, arthritis, osteoporosis, CKD, incontinence and godawful daytime TV, they’ll wish they had.
And if questioning what the medical profession is trying to achieve, exactly, sounds a bit existential, let’s bring this right down to earth by pointing out that many of the people we ‘save’ will end up in residential care. So our efforts will just increase our own workload – as of next year, ‘enhanced health in care homes’ will be a service specification policed with a very big and painful stick. I’d tell you where I read that, but I promised I wouldn’t.
Dr Tony Copperfield is a GP in Essex. Read more of Copperfield's blogs at http://www.pulsetoday.co.uk/views/copperfield or follow him on Twitter @doccopperfield