In his article on the new GMS contract’s hypertension indicators (‘Tackling hypertension will help to reduce cardiovascular risk’ Guidelines in Practice February 2004, pp. 28-33), Dr Alan Begg states that the hypertension register should exclude the subgroups who have coronary heart disease, stroke and diabetes.
We had assumed that the hypertension register would contain as sub-populations those patients with raised blood pressure who were also on the CHD, stroke and diabetes registers. The work done in lowering blood pressure would therefore be amply rewarded. Indeed, hypertension – like smoking cessation advice – was initially seen as a ‘quick win’ for practices because the reward would be spread across several disease areas.
I therefore approached the helpdesk of the National Primary Care Development Team, who responded with the following advice:
“There are no exclusions from the hypertension register – patients with CHD, stroke or diabetes can also be included on the hypertension register if they have also been diagnosed with established hypertension."
Clinical Governance/ Clinical Risk Manager
East Surrey PCT
Dr Alan Begg replies:
Ms Walton raises an important point. Clarity over what is included in individual disease registers will give more accurate comparative prevalence rates. The new contract is disease-category specific, so there is logic in clearly identifying high-risk patients with target organ damage or diabetes. Outcomes in these patients will be improved by lowering blood pressure as far as possible, and not just to the audit standard specified in the quality and outcomes framework.
Dr Alan Begg, GP, Montrose