Tougher BP targets in QOF approved by NICE

GPs are set for stricter BP targets for patients with vascular disease under proposals from NICE for next year's QOF.

Patients with vascular disease would need to be treated to lower BP targets under the proposals
Patients with vascular disease would need to be treated to lower BP targets under the proposals

Patients aged under 80 should be treated to reach a BP of 140/90 or less if they have a history of CHD, stroke or TIA, or peripheral artery disease, NICE's QOF advisory committee ruled.

The current target is 150/90 for these patients, and this would remain the target for patients aged 80 and over.

Concerns had been raised during the meeting that aggressive treatment to lower BP may not be appropriate for all patients.

Committee chairman Dr Colin Hunter said to avoid potential harm the targets must permit higher exception reporting rates or lower thresholds, so that inappropriate patients can be exempted.

It comes after the government imposed a steep rise in thresholds in this year's QOF.

At the meeting in Manchester on Wednesday, NICE advisors also approved indicators for confirming hypertension diagnoses using ambulatory or home BP monitors.

Other indicators accepted included referring suspected dementia cases to memory services and entering carers' details on dementia patients' records.

They also approved targets for giving contraceptive and pregnancy advice to women with diabetes.

Recommended indicators are approved by NICE before being placed on a 'menu' of targets in August. The GPC and NHS Employers will then negotiate on which indicators should enter next year's QOF.

Over-treatment concerns
In pilots for the new BP indicators, practices raised concerns over the targets' difficulty, the risks of polypharmacy and over-treatment, and the expected rise in exception reporting.

However, about 60% of the 37 pilot practices backed the targets, although about 20% said they shouldn't be included in the QOF. Others were ambivalent.

For CHD, 43% of practices said they were already working to a target of 140/90 or less.

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