audit at GP

1. An Audit on The Management of
Hypertension In Newly Diagnosed
Patients
Nurdalila Sahidan
5th Year Medical Student
February 2012
Supervisor: Dr Manisha Kumar

2. INTRODUCTION:
HYPERTENSION
 Hypertension is a major modifiable risk factor for
cardiovascular disease which can be controlled and
monitored through good primary care practice
 1 in 4 middle-age adult in the UK have high blood pressure
 Treatment includes lifestyle changes- losing weight if you are
overweight, regular exercises, a healthy diet, stop smoking,
and a low salt and caffeine intake
 Medication can also be offered to lower the blood pressure
 The clinical management of hypertension is one of the most
common interventions in primary care, accounting for
approximately £1 billion in drug costs alone in 2006.

3. METHODS
 Data collection
 Newly diagnosed hypertensive patients from
December 2011 to February 2012
 12 cases reviewed
 Data analysis
 Based on the NICE guidance and The Quality of
Outcomes Framework (QOF)

4. EVALUATION

5. RESULTS
Criterion 1: 80% of patients who has
clinic blood pressure 140/90 mmHg or
higher, should be offered ABPM to
confirm the diagnosis of hypertension
Criterion 2: 80% of patients
confirmed to have hypertension
should be started on
antihypertensive drug

6.  1 patient has reason documented: ? White coat
syndrome in two separate ocassions
December(167/96), January (148/89)
 2 patients do not have any reason documented
 One of them is 18 years old with bp 158/82 and
161/92 in 2 separate ocassions. The patient is
obese with BMI of 37.98

7. RESULTS
Criterion 3: 80% of patients confirmed to have hypertension or
awaiting confirmation should be investigated for target organ damage
A=Urine sample for albumin:creatinine
ratio
B=Blood sample:measure glucose,
electrolytes, creatinine, eGFR and
cholesterol
C=Examination of fundi for the
presence of hypertensive retinopathy
D=12-lead electrocardiography

8. RESULTS
Criterion 4: 80% of hypertensive
patients should be assessed for
CVD risk
Exception: Person has pre-existing CHD,
angina, stroke, PVD, diebetes and familial
hypercholesterolaemia
Criterion 5: 80% of hypertensive
patients should be given lifestyle
advice such as quit smoking, regular
excercise, healthy diet and weight
loss
Yes No
100% 0%

9. RESULTS
Criterion 6: 80% patients who are 55 years or older or Black people
of African or Caribbean should be offered CCB
 1 patient experienced side effect
such as oedema
 1 patient is treated with B-Blocker
when he was in Pakistan
1 patient has no reason
documented

10. RESULTS
Criterion 7: 80% patients younger than 55 years should be
offered ACE inhibitor or ARB
 1 patient is on CCB.Stated in
the notes “as per NICE
Guidance” but the ethnicity is
not recorded.
 1 patient has no reason
documented.

11. ASSUMPTION AND LIMITATION
 If the origin of a patient is not stated in the patient’s
notes as African-Caribbean or black origin,
assumption is made to consider that patient as
Caucasian or Asian
 This audit has small number of samples (12) which
might create bias
 Some patients were treated by their previous GP in
their home country with another medication
 Patient does not attend the appointment

12. RECOMMENDATIONS
 Re-audit with appropriate number of samples
 Increase awareness among GP to check for :i)
urine sample for albumin:creatinine ratio, ii) blood
sample:measure glucose, electrolytes, creatinine,
eGFR and cholessterol, iii) examination of fundi for
the presence of hypertensive retinopathy, iv) 12-
lead electrocardiography, v) CVD risk assessment
 Ensure that patient details such as ethnicity,
smoking status and weight is recorded
 Ensure to document any reason for starting or
discontinue any medication

13. THANK YOU