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GP-led management of hypertension ‘has saved thousands of lives’

GPs have doubled treatment rates for hypertension over the past decade in England, resulting in tens of thousands of lives being saved every year, the authors of a nationwide study have concluded.

The team from Imperial College London analysed Health Survey for England data collected between 1994 and 2011, and found 58% of adults diagnosed with hypertension were receiving treatment by the end of this period, compared with 32% at the beginning.

Moreover, the proportion of these patients whose blood pressure was controlled to below 140/90 mmHg has more than tripled between 1994 and 2011, up from 11% to 37%.

The authors estimate the improvements in management have likely saved tens of thousands of deaths from major cardiovascular events year on year. If the trend continues, they say, around 80% of patients with treated hypertension will have controlled blood pressure by 2022, potentially saving around 50,000 cardiovascular events a year.

Lead author Dr Emanuela Falaschetti said: ‘Although the rates of diagnosis, treatment and control of raised blood pressure remain suboptimum in England, our findings are still a cause for optimism.

‘Whereas once the “rule of halves” prevailed – half the general population with high blood pressure were diagnosed, half of those detected treated, and half of those treated controlled – now management in England is better than the rule of two-thirds. As a result of these improvements in practice, several hundreds of thousands of major cardiovascular events might have been prevented.’

Professor Richard McManus, professor of primary care at University of Oxford, and Professor Jonathan Mant, professor of primary care research at University of Cambridge, wrote in a related commentary: ‘Many public health initiatives aim to reduce the population burden of hypertension and along with physicians in primary care – who provide most hypertension management in the UK – have led to substantial advances in hypertension management and blood pressure control.’

Lancet 2014; available online 30 May