Drug management of hypertension in primary care

Abstract

The management of hypertension in primary care continues to represent a significant burden on the NHS, both clinically and financially (Box 1). Recent estimates suggest that around 16 million people in the UK have hypertension (Blood Pressure Association 2005), which accounts for around 37 per cent of men and 34 per cent of women (Department of Health (DH) 2002). According to the World Health Organization (WHO), the global disease burden attributable to a systolic blood pressure of 115 mmHg or above is significant. It accounts for around seven million deaths each year (WHO 2005), 49 per cent of coronary heart disease cases and 62 per cent of strokes (Maryon-Davis et al 2005). A recent study showing that the burden of stroke is greater than that of heart disease highlights the significance of these figures (Rothwell et al 2005). Hypertension is also costly. In 1999 alone, a cost to the NHS of at least £7 billion could be attributed directly or indirectly to hypertension (Maryon-Davis et al 2005). Considerable efforts are being made to improve hypertension management both in primary and secondary care settings. The new GMS contract offers incentives for improving the detection and control of blood pressure with a significant number of the clinical points for additional payments in the Quality and Outcome framework (QOF) being for hypertension (BMA, 2003). The National Service Frameworks (NSFs) for Coronary Heart Disease (DH 2000), Older People (DH 2000) and Diabetes (DH 2001) all highlight the importance of detecting and monitoring high blood pressure and recommend targets for control. With the increasing incidence of conditions such as diabetes and obesity – both of which are strongly linked to high blood pressure – the number of people with hypertension looks set to rise. The review, therefore, of government recommendations for the management of hypertension is both timely and necessary. New joint guidelines on the management of hypertension in adults in primary care are expected Drug management of hypertension in primary care