This document summarizes an audit on the management of hypertension in newly diagnosed patients. The audit evaluated 12 newly diagnosed hypertensive patients based on 7 criteria from NICE guidance and Quality and Outcomes Framework. The results found that most criteria were met for over 80% of patients, except for confirming the diagnosis with ambulatory blood pressure monitoring and documenting reasons for medication choices. The audit limitations included its small sample size and some patients previously being treated abroad. Recommendations include re-auditing with a larger sample, improving documentation of patient details and test/risk results, and documenting medication reasons.

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