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Blood pressure referrals to ‘go through the roof’

By Lilian Anekwe

Exclusive: New guidance that recommends GPs offer all patients with suspected hypertension ambulatory blood pressure monitoring is likely to overwhelm specialist hospital services, cardiologists have warned.

Hospital consultants have warned they do not have the capacity to meet demand from GPs who refer patients for ABPM – and believe the new guidance will actually delay the diagnosis of patients.

It comes as GPs warned that practices were unlikely to purchase the monitoring devices, which cost £1,000, and were likely to refer patients to secondary care instead – sending referrals ‘through the roof’.

A Pulse snapshot survey of 15 cardiology departments around the country found that four in five do not currently have adequate capacity to offer ABPM to all newly diagnosed patients referred from primary care.

More than half of those who responded to our survey said waiting for referral would delay diagnosis. Two-thirds of specialists believe patients’ access to ABPM may be delayed, while a similar proportion disagree with NICE’s claim that the switch to ABPM will ‘ultimately be cost-saving to the NHS’.

The draft guidance, out for consultation until 22 March, signals a massive shake-up in the diagnosis of hypertension. It urges GPs to abandon their current practice of taking a series of blood pressure readings in clinic, and instead offer 24-hour ABPM to all patients who have two in-clinic readings over 140/90 mm Hg in order to confirm the diagnosis.

Dr Anna-Maria Choy, consultant in cardiology at Ninewells Hospital in Dundee, said: ‘It will delay true hypertensive patients getting treatment and will have an impact on the hospitals providing this service and expertise in analysing and interpreting results.’

Dr Tim Cripps, lead doctor at the Bristol Heart Institute, said: ‘We don’t have the capacity at present and we have a significant waiting list.’

Even GPs who helped write the guidance said practices were unlikely to purchase the devices to use in primary care.

Dr Terry McCormack, a GPSI in cardiovascular medicine in Whitby, North Yorkshire and NICE guideline development committee member, said: ‘It may be that GPs are able to refer, but the capital outlay may not be something that GPs are willing to take on.’

And Dr Julian Hall, a GP in Halesowen in the West Midlands, said: ‘Buying in expensive equipment is only realistic for big practices. GPs will end up referring to secondary care and I foresee secondary care referrals going through the roof.’

Blood pressure referrals to ‘go through the roof’