Table 2

Guideline and policy changes related to the ongoing management of hypertension

Guideline/policy/QOF indicator1998/
1999		1999/
2000		2001/
2002		2001/
2002		2002/
2003		2003/
2004		2004/
2005		2005/
2006		2006/
2007		2007/
2008		2008/
2009		2009/
2010		2010/
2011		2011/
2012		2012/
2013		2013/
2014		2014/
2015		2015/
2016
NICE Clinical Guideline 18 (2004): Essential hypertension: managing adult patients in primary care.✓✓
NICE Clinical Guideline 34 (2006): Management of hypertension in adults in primary care.✓✓✓✓✓
NICE Clinical Guideline 127 (2011): Hypertension in adults: diagnosis and management✓✓✓✓✓
Policy change: NHS health check cardiovascular risk screening programme introduced.✓✓✓✓✓✓✓
QOF hypertension indicator: The percentage of patients with hypertension in whom there is a record of the blood pressure in the previous 9 months.✓✓✓✓✓✓✓✓✓
QOF hypertension indicator: The percentage of patients with hypertension in whom the last blood pressure (measured in the previous 9 months) is 150/90 or less.✓✓✓✓✓✓✓✓✓✓✓✓
QOF hypertension indicator: The percentage of patients aged 79 or under with hypertension in whom the last blood pressure reading (measured in the preceding 9 months) is 140/90 mm Hg or less.✓
QOF hypertension indicator: The percentage of patients with hypertension who have not attained the age of 75 in whom there is an assessment of physical activity, using GPPAQ, in the preceding 12 months.✓
QOF hypertension indicator: The percentage of patients with hypertension aged 16 or over and who have not attained the age of 75 who score ‘less than active’ on GPPAQ in the preceding 12 months, who also have a record of a brief intervention.✓
QOF blood pressure indicator: The percentage of patients aged 40 or over who have a record of blood pressure in the preceding 5 years.✓✓✓✓✓✓✓✓✓✓✓✓
QOF smoking indicator: The percentage of patients with hypertension who smoke whose notes contain a record that smoking cessation advice or referral to a specialist service, where available, has been offered within the previous 15 months.✓✓✓✓✓✓✓✓✓✓✓✓
QOF smoking indicator: The percentage of patients with hypertension whose notes record smoking status in the previous 15 months. Except those who have never smoked where smoking status need only be recorded once since diagnosis.✓✓✓✓✓✓✓✓✓✓✓✓
QOF smoking indicator: The contractor supports patients who smoke in stopping smoking by a strategy which includes providing literature and offering appropriate therapy.✓✓✓
QOF primary prevention of cardiovascular disease indicator: In those patients with a new diagnosis of hypertension: the percentage of patients who have had a face-to-face cardiovascular risk assessment at the outset of diagnosis using an agreed risk assessment tool.✓✓✓✓
QOF primary prevention of cardiovascular disease indicator: The percentage of people diagnosed with hypertension who are given lifestyle advice for increasing physical activity, smoking cessation, safe alcohol consumption and healthy diet.✓✓✓✓✓
QOF primary prevention of cardiovascular disease indicator: In those patients with a new diagnosis of hypertension, who have a recorded CVD risk assessment score of ≥20% in the preceding 12 months: the percentage who are currently treated with statins✓✓✓

  • Columns highlighted in dark grey indicate prespecified cut points, and column in light grey indicates additional post hoc cut point for interrupted time-series analysis.

  • CVD, cardiovascular disease; GPPAQ, General Practice Physical Activity Questionnaire; NHS, National Health Service; NICE, National Institute for Health and Care Excellence; QOF, quality and outcomes framework.