QOF

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BP codes

BP Exception code (Added in the last 12 months)

8I3Y. Blood pressure procedure refused

Maximum BP therapy (In last 12 months)

8BL0. Patient on maximal tolerated antihypertensive therapy

BP Codes (In last 12 months)

The latest Systolic <=150 and Diastolic <=90

246% O/E - blood pressure reading,

Excluding:

2460 O/E - BP unrecordable (v7)
2468. O/E - BP reading:postural drop
246H. O/E - Arterial pressure index normal
246I. O/E - Arterial pressure index abnormal
246K. Target systolic blood pressure
246L. Target diastolic blood pressure
246M. White coat hypertension
246h. Arterial pulse pressure
246i. Diastolic blood pressure centile
246j. Systolic blood pressure centile
246k. Unequal blood pressure in arms

In detail:

246. O/E - blood pressure reading
2461. O/E - BP reading very low
2462. O/E - BP reading low
2463. O/E - BP borderline low
2464. O/E - BP reading normal
2465. O/E - BP borderline raised
2466. O/E - BP reading raised
2467. O/E - BP reading very high
2469. O/E - Systolic BP reading
246A. O/E - Diastolic BP reading
246B. O/E - BP stable
246C. Lying blood pressure reading
246D. Standing blood pressure reading
246E. Sitting blood pressure reading
246F. O/E - blood pressure decreased
246G. O/E - BP labile
246J. O/E - BP reading: no postural drop
246N. Standing systolic blood pressure
246P. Standing diastolic blood pressure
246Q. Sitting systolic blood pressure
246R. Sitting diastolic blood pressure
246S. Lying systolic blood pressure
246T. Lying diastolic blood pressure
246Z. O/E-blood pressure reading NOS
246a. Average night interval diastolic blood pressure
246b. Average night interval systolic blood pressure
246c. Average home diastolic blood pressure
246d. Average home systolic blood pressure
246e. Ambulatory systolic blood pressure
246f. Ambulatory diastolic blood pressure
246g. Self measured blood pressure reading
246l. Average systolic blood pressure
246m. Average diastolic blood pressure
246n. Baseline blood pressure (v30)

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Hypertension exception reporting codes

9h3.. Exception reporting: hypertension quality indicators
9h31. Excepted from hypertension quality indicators: Patient unsuitable
9h32. Excepted from hypertension quality indicators: Informed dissent

Hypertension exception

G250. Stage 1 hypertension (NICE 2011) without evidence of end organ damage

HYP 006.1 Rationale

This indicator measures the intermediate health outcome of a blood pressure of 150/90 or less in patients with hypertension. Its intent is to promote the primary and secondary prevention of CVD through satisfactory blood pressure control. This intermediate outcome can be achieved through lifestyle advice and the use of drug therapy.

The NICE clinical guideline on Hypertension recommends drug therapy in patients who are aged 79 or under with stage 1 hypertension who have one or more of the following:

The NICE guideline recommends that antihypertensive drug treatment for patients of any age with stage 2 hypertension.

The guideline recommends that a referral for specialist evaluation of secondary causes of hypertension and a more detailed assessment of potential target organ damage is considered for patients aged 39 or under with stage 1 hypertension and no evidence of target organ damage, CVD, renal disease or diabetes. This is because 10-year cardiovascular risk assessments can underestimate the lifetime risk of cardiovascular events in these patients.

The guideline also recommends that patients with hypertension have their care reviewed annually to monitor blood pressure, provide support and discuss lifestyle, symptoms and medication. However, the frequency of follow-up depends on factors such as the severity of hypertension, variability of blood pressure, complexity of the treatment regime, patient compliance and the need for non-pharmacological advice.

For the purpose of QOF, a measurement of 150/90 mmHg has been adopted for this indicator.

Further information

NICE public health guidance 25 (2010). Prevention of CVD.
http://guidance.nice.org.uk/PH25/Guidance/pdf/English

HYP 006.2 Reporting and verification

See indicator wording for requirement criteria.

Prepared By Jean Keenan