Intended for healthcare professionals

Rapid response to:

Education And Debate

British Hypertension Society guidelines for hypertension management 1999: summary

BMJ 1999; 319 doi: (Published 04 September 1999) Cite this as: BMJ 1999;319:630

Rapid Response:

British Guidelines on Hypertension Do not consider Workload Implications In Primary Care

The new Joint British Societies' recommendations on prevention of
coronary heart disease appear to have been introduced without any apparent
consideration of workload implications for general practice .

By lowering the threshold for treatment they have created huge
numbers of new hypertensive patients. Each patient will require
assessment, work-up and several appointments before control is acceptable
both to the clinician and the patient. A conservative estimate is that an
average, newly identified hypertensive will need four appointments a year,
especially in the first 12 months.

Exactly how many extra patients each GP and practice nurse will be
expected to see each week is very difficult to quantify. However, it
should be realised that in addition to new hypertensives requiring
treatment there are established hypertensives who are now no longer
controlled and new hyperlipidaemic patients.

A partial solution is that practices who are committed to the
Guidelines be given the extra resources needed (mainly a limited increase
in practice nurse hours). If this does not happen, then surgeries will be
increasingly clogged up with patients having preventative care at the
expense of those who wish to seek advice because they feel ill.

It is unfortunate that the Joint Societies do not appear to have had
any significant involvement with GPs when developing their Guidelines.

GPs tend to blame their excessive and sometimes demoralising
workloads on "high patient demand". It may be that on this occasion that
"high professorial demand" is to blame.

John Eisenberg


Macklin Street Surgery,
Macklin Street,

1.Ramsay LE, Williams B, Johnston GD, et al. British Hypertension
Society guidelines for hypertension management 1999: summary. BMJ 1999:

2.Joint British recommendations on prevention of coronary heart
disease in clinical practice. HEART. Supplement 2 December 1998 Vol 80

Competing interests: No competing interests

16 October 1999
John Eisenberg