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NICE proposes different blood pressure targets in over-80s

Patients over 80 years will have a lower target blood pressure under proposed indicators for next year's QOF.

NICE is proposing that hypertension indicators in the QOF differ by age for the first time, with a blood pressure target of 140/90 mmHg or less for patients aged 80 years or older.

This compares with a target of 150/90 or less for patients younger than this, and would replace the current BP5 indicator worth 55 QOF points.

The indicators will go forward as part of the menu of indicators to be considered by the GPC and NHS Employers, who make the final decision on whether they will be included in the  2013/2014 QOF.

The indicators were piloted in 30 practices, 57% of whom felt that the two indicators together were acceptable and would ensure consistency between QOF and NICE guidance.

Dr Terry McCormack, GP and cardiovascular lead in North Yorkshire, said he agreed with the new indicators as they follow the evidence from trials in the elderly.

He said: ‘I believe it is important to have different targets for different ages.

‘I also worry about the very tight targets for CKD and diabetes which do not allow for age or infirmity. I feel these indicators should be looked at also.'

But Dr Chaand Nagpaul, GPC negotiator said: ‘We charge NICE with the task of reviewing evidence and if they deem that there is evidence to differentiate target blood pressure levels by age then we will review the evidence for these new indicators.

‘However, we're not working in an open-ended framework, we're working with a finite resource. We have to look at changes to the QOF in the context that GPs have had an increase to their workload.'


Full wording of the indicators:

The percentage of patients under 80 years old with hypertension in whom the last recorded blood pressure (measured in the preceding 9 months) is 140/90 or less.

The percentage of patients aged 80 years and over with hypertension in whom the last recorded blood pressure (measured in the preceding 9 months) is 150/90 or less.