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8BL0. Patient on maximal tolerated antihypertensive therapy
246% O/E - blood pressure reading,
This indicator measures the intermediate health outcome of a blood pressure of 150/90 or less in patients with hypertension and CHD. Its intent is to promote the secondary prevention of CVD through satisfactory blood pressure control. This intermediate outcome can be achieved through lifestyle advice and the use of drug therapy.
In one major overview, a long-term difference of 5 - 6 mmHg in usual diastolic blood pressure (DBP) is associated with approximately 35 - 40 per cent less stroke over five years. The PROGRESS trial demonstrated that blood pressure lowering reduces stroke risk in patients with prior stroke or TIA.
The NICE clinical guideline on Hypertension (2011) sets blood pressure thresholds for the initiation of drug treatment of hypertension and these are outlined in the rationale for the hypertension domain. To summarise, all patients aged under 80 years with CVD and stage 1 hypertension (clinic blood pressure is 140/90 mmHg or higher and subsequent ambulatory blood pressure monitoring (ABPM) daytime average or home blood pressure monitoring (HBPM) average blood pressure is 135/85 mmHg or higher) are recommended drug therapy for hypertension.
The SIGN clinical guideline (2008) recommends that patients who have had a stroke or TIA and have hypertension should be treated to less than 140/85 mm Hg.
The NICE clinical guideline on Hypertension (2011) recommends a target clinic blood pressure below 140/90 mmHg in patients aged under 80 years with treated hypertension and a clinic blood pressure below 150/90 mmHg in patients aged 80 years and over, with treated hypertension.
For the purpose of QOF, an audit standard of 150/90 has been adopted.
SIGN guideline 108 (2008). The Management of patients with stroke
RCP Stroke Guideline (2008).
NICE clinical guideline CG127 (2011). Hypertension.
Collins et al. Lancet 1990; 335: 827-38
PROGRESS Collaborative Group, Lancet 2001; 358:1033-41
See indicator wording for requirement criteria.
Prepared By Jean Keenan