Cut down on blood tests in hypertension reviews, GP researchers conclude
Patients with hypertension may be having more blood tests than they need, say researchers who found many routinely ordered tests may not be beneficial.
A review looked at a wide range of tests that are commonly ordered in general practice but with substantial variation and potentially not in line with the evidence.
The team from Bristol University concluded that a minimum testing panel for reviewing patients with hypertension should include estimated glomerular filtration rate to screen for chronic kidney disease, and HbA1c to screen for diabetes.
In addition, testing for potassium for patients on angiotensin-converting enzyme inhibitors, and angiotensin II receptor blockers and sodium for patients on thiazide-type diuretics was also supported by the evidence.
But there was no good data to back the routine measurement of lipids, electrolytes, haemoglobin, thyroid function, clotting biomarkers, calcium, ferritin, folate acid, or vitamin B12, they wrote in the British Journal of General Practice.
Even stronger was the evidence that there is no benefit in routinely monitoring liver function, inflammation markers, or brain natriuretic peptide, they added.
As part of the study, a consensus panel agreed that ‘in the absence of evidence or clinical need these tests should not be offered to people with hypertension’.
‘Unnecessary testing could be prevented if guidelines and local protocols recommended minimal testing sets and made clear additional tests should only be added if clinically indicated’, they noted.
The team are now planning a randomised controlled trial to look at tests offered in general practice for long-term conditions more closely.
Previous studies have shown most patients with long-term conditions receive more tests than is recommended.
Use of laboratory tests in primary care increased four-fold between 2000 and 2015, with disease monitoring and medication monitoring accounting for around 30% and 10% of primary care testing, respectively, the researchers explained.
Overtesting is a waste of NHS resources but can also lead to harm including patient anxiety, unnecessary referrals and overdiagnosis, they pointed out.
‘Educating GPs and staff requesting tests about the harms of overtesting may help avoid tests being added “just in case” or “because we have always done this”’, they wrote.
Their upcoming trial will also look at the best testing frequency, which may not be annually, they added.
Meanwhile, GP practices will be monitored by ICBs on ‘immediate’ priorities to improve prevention and care for patients with cardiovascular disease, as the Government announced a new framework for cardiovascular disease prevention and care.
Visit Pulse Reference for details on 140 symptoms, including easily searchable symptoms and categories, offering you a free platform to check symptoms and receive potential diagnoses during consultations.
