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GPs should ignore QOF targets for hypertension, says former RCGP president



GPs should resist the ‘trend towards overtreatment’ in patients with mild hypertension and only prescribe antihypertensives for those at blood pressures of 160/100 mmHg or higher, argues former RCGP president Dr Iona Heath.

Dr Heath says that current QOF hypertension targets are unnecessary, at odds with guidelines and are leading to overtreatment.

Writing in a Viewpoint article in JAMA Internal Medicine, Dr Heath says: ‘In view of the mounting evidence of both waste and harm, it is well time that we returned to the higher threshold of 160/100 mmHg for the pharmaceutical treatment of hypertension in otherwise healthy people.’

Dr Heath highlights that a Cochrane review published last year found no reductions in mortality or morbidity from treating people with a systolic blood pressure of 140 to 159 mmHg and/or a diastolic blood pressure of 90–99 mmHg with antihypertensive drugs.

She also cites NICE guidance that recommends drug treatment in people with stage 1 hypertension (below 160/100 mmHg) only if they have other risk factors.

In this context, the QOF indicator HYP002, which awards points for the percentage of patients with hypertension with blood pressure no more than 150/90 mmHg, ‘drives the medicating of many people with stage 1 hypertension who have no comorbidity and who, according to the Cochrane review, will derive no benefit’, argues Dr Heath.

The indicator HYP003 introduced this year requires GPs to treat patients under 80 years of age at the even lower threshold of 140/90 mmHg.

Dr Heath writes: ‘In British general practice, enmeshed as it is in a web of guidelines that are underwritten by the payment-by-results targets of the QOF, it has become increasingly difficult to resist the trend towards overtreatment.’

JAMA Intern Med 2013; available online 13 May