Letters

Audit of diagnosis and management of hypertension in primary care

BMJ 1997; 315 doi: http://dx.doi.org/10.1136/bmj.315.7103.314a (Published 02 August 1997) Cite this as: BMJ 1997;315:314

Interpractice variation in prevalence of hypertension is due to inadequate detection

  1. Kevin Allan, Health information managera,
  2. Paul Murphy, MEDICS project facilitatora,
  3. Stephen Singleton, Director of public healtha,
  4. Richard Edwards, Lecturerb
  1. a Northumberland Health Authority, Morpeth NE61 2PD
  2. b Department of Epidemiology and Public Health, Newcastle University Medical School, Newcastle upon Tyne NE1 7RU
  3. c Prescribing Research Group, Department of Pharmacology and Therapeutics, The Infirmary, Liverpool L69 3GF
  4. d Chelsea and Westminster Hospital, London SW10 9NH

    Editor—An interpractice audit of the diagnosis and management of hypertension in primary care found that hypertension remained uncontrolled in over three fifths of hypertensive patients despite the implementation of an intensive audit; this is disappointing.1 Another common deficiency in the management of hypertension—the failure of health care services to detect and diagnose the condition—was not, however, addressed.

    Data from table 1 in the paper can be used to calculate the crude prevalence of hypertension in individual practices. This varied between 1.61% and 5.01% (mean 3.2%) during phase 1 of the study, which suggests that the detection of hypertension varied widely. This is confirmed by data from the MEDICS (morbidity and epidemiology data interchange and comparison scheme) project in Northumberland. Prevalence data for common chronic diseases have been collected from computerised records at 33 practices covering a population of 200 000 people. In March 1995 the crude prevalence of recorded hypertension in adults (aged >15) varied from 3.0% to 13.2% (mean 6.7%)—from 2.6% to 10.9% (mean 5.5 %) in men and 3.4% to 15.6% (mean 7.9%) in women. This variation persisted when data were indirectly standardised for age and expressed as standardised morbidity ratios.

    MEDICS practices should probably be better than most at detecting and recording hypertension because they are all computerised, provide data on the prevalence of hypertension for the health promotion banding scheme, and participate in a project collecting morbidity data. They are also situated in a district …

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