Skip to main content
PMC home page
The British Journal of General Practice logoLink to The British Journal of General Practice
. 1998 Jul;48(432):1424–1428.

Auditing the management of hypertension in British general practice: a critical literature review.

M Cranney 1, S Barton 1, T Walley 1
PMCID: PMC1313140  PMID: 9800405

Abstract

Hypertension is a common condition almost exclusively managed by general practitioners (GPs), making it an ideal subject for practice-based audit. However, the conduct and interpretation of such audits is complex. Even minor variations in methodology can produce dramatic differences in results obtained. We used a focus group of seven GPs with a special interest in audit to establish a standardized method for the planning and reporting of audits for the management of hypertension. In order to enhance the reliability and comparability of hypertension audits, 13 key areas of audit methodology were produced by the focus group. Eleven audits were identified in a literature search using pre-determined selection criteria. These were then assessed to compare their methodology with the criteria produced by the focus group. None of the recently published audits in this subject covered all of the key areas (range: 27-65% of the areas covered). One key area, that of digit preference, was not mentioned by any. Other problematic key areas included the selection of patient records without bias, the determination of the prevalence of hypertension, the number of recordings used to determine the diagnosis of hypertension and its subsequent control, the time period examined by the audit, and the approach taken to notes containing an inadequate number of blood pressure recordings. Significant variability in the methods used by different authors in these key areas calls into question the reliability of their results and makes comparisons between them very difficult. We propose a standardized method for hypertension audits comprising 13 key areas, which will enhance the reliability of results and facilitate such comparisons.

Full Text

The Full Text of this article is available as a PDF (33.7 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aylett M., Creighton P., Jachuck S., Newrick D., Evans A. Blood pressure control of drug treated hypertension in 18 general practices. J Hum Hypertens. 1996 Aug;10(8):547–550. [PubMed] [Google Scholar]
  2. Barton S., Cranney M., Hatcher J., Walley T. The risk of cardiovascular disease in hypertensive patients. Br J Gen Pract. 1997 Mar;47(416):182–182. [PMC free article] [PubMed] [Google Scholar]
  3. Barton S., Cranney M., Walley T. Comparing hypertension guidelines. Technical difficulties may have affected study's results. BMJ. 1996 Nov 9;313(7066):1204–1204. doi: 10.1136/bmj.313.7066.1204. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Chapman A., Ridout S. Hypertensive care and the small practice. Practitioner. 1989 Jul 8;233(1472):1018–1022. [PubMed] [Google Scholar]
  5. Dickerson J. E., Brown M. J. Influence of age on general practitioners' definition and treatment of hypertension. BMJ. 1995 Mar 4;310(6979):574–574. doi: 10.1136/bmj.310.6979.574. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Donner A., Klar N. Methods for comparing event rates in intervention studies when the unit of allocation is a cluster. Am J Epidemiol. 1994 Aug 1;140(3):279–301. doi: 10.1093/oxfordjournals.aje.a117247. [DOI] [PubMed] [Google Scholar]
  7. Du X., Cruickshank K., McNamee R., Saraee M., Sourbutts J., Summers A., Roberts N., Walton E., Holmes S. Case-control study of stroke and the quality of hypertension control in north west England. BMJ. 1997 Jan 25;314(7076):272–276. doi: 10.1136/bmj.314.7076.272. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Fahey T. P., Peters T. J. A general practice-based study examining the absolute risk of cardiovascular disease in treated hypertensive patients. Br J Gen Pract. 1996 Nov;46(412):655–659. [PMC free article] [PubMed] [Google Scholar]
  9. Fahey T. P., Peters T. J. What constitutes controlled hypertension? Patient based comparison of hypertension guidelines. BMJ. 1996 Jul 13;313(7049):93–96. doi: 10.1136/bmj.313.7049.93. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Fahey T., Lancaster T. The detection and management of hypertension in the elderly of Northamptonshire. J Public Health Med. 1995 Mar;17(1):57–62. [PubMed] [Google Scholar]
  11. Fahey T., Silagy C. General practitioners' knowledge of and attitudes to the management of hypertension in elderly patients. Br J Gen Pract. 1994 Oct;44(387):446–449. [PMC free article] [PubMed] [Google Scholar]
  12. Haigh A. Hypertension in the elderly. Practitioner. 1989 May 22;233(1469):735–738. [PubMed] [Google Scholar]
  13. Harriss C., Pringle M. Do general practice computer systems assist in medical audit? Fam Pract. 1994 Mar;11(1):51–56. doi: 10.1093/fampra/11.1.51. [DOI] [PubMed] [Google Scholar]
  14. Hart J. T. Semicontinuous screening of a whole community for hypertension. Lancet. 1970 Aug 1;2(7666):223–226. doi: 10.1016/s0140-6736(70)92582-1. [DOI] [PubMed] [Google Scholar]
  15. Hart J. T., Thomas C., Gibbons B., Edwards C., Hart M., Jones J., Jones M., Walton P. Twenty five years of case finding and audit in a socially deprived community. BMJ. 1991 Jun 22;302(6791):1509–1513. doi: 10.1136/bmj.302.6791.1509. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Jackson R., Barham P., Bills J., Birch T., McLennan L., MacMahon S., Maling T. Management of raised blood pressure in New Zealand: a discussion document. BMJ. 1993 Jul 10;307(6896):107–110. doi: 10.1136/bmj.307.6896.107. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Jones J. K., Gorkin L., Lian J. F., Staffa J. A., Fletcher A. P. Discontinuation of and changes in treatment after start of new courses of antihypertensive drugs: a study of a United Kingdom population. BMJ. 1995 Jul 29;311(7000):293–295. doi: 10.1136/bmj.311.7000.293. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Kronmal R. A., Cain K. C., Ye Z., Omenn G. S. Total serum cholesterol levels and mortality risk as a function of age. A report based on the Framingham data. Arch Intern Med. 1993 May 10;153(9):1065–1073. [PubMed] [Google Scholar]
  19. Lawrence M., Coulter A., Jones L. A total audit of preventive procedures in 45 practices caring for 430,000 patients. BMJ. 1990 Jun 9;300(6738):1501–1503. doi: 10.1136/bmj.300.6738.1501. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Mant D., McKinlay C., Fuller A., Randall T., Fullard E. M., Muir J. Three year follow up of patients with raised blood pressure identified at health checks in general practice. BMJ. 1989 May 20;298(6684):1360–1362. doi: 10.1136/bmj.298.6684.1360. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Meagher P. F., Deery C., Linton A. F., Craig T. J., Leeson P. J. An audit of hypertensive care in general practice. Ir Med J. 1993 Jan;86(1):20–22. [PubMed] [Google Scholar]
  22. Myers M. G., Carruthers S. G., Leenen F. H., Haynes R. B. Recommendations from the Canadian Hypertension Society Consensus Conference on the Pharmacologic Treatment of Hypertension. CMAJ. 1989 May 15;140(10):1141–1146. [PMC free article] [PubMed] [Google Scholar]
  23. Payne J. N., Milner P. C., Saul C., Bowns I. R., Hannay D. R., Ramsay L. E. Local confidential inquiry into avoidable factors in deaths from stroke and hypertensive disease. BMJ. 1993 Oct 23;307(6911):1027–1030. doi: 10.1136/bmj.307.6911.1027. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Poulter N. R., Zographos D., Mattin R., Sever P. S., Thom S. M. Concomitant risk factors in hypertensives: a survey of risk factors for cardiovascular disease amongst hypertensives in English general practices. Blood Press. 1996 Jul;5(4):209–215. doi: 10.3109/08037059609079673. [DOI] [PubMed] [Google Scholar]
  25. Sever P., Beevers G., Bulpitt C., Lever A., Ramsay L., Reid J., Swales J. Management guidelines in essential hypertension: report of the second working party of the British Hypertension Society. BMJ. 1993 Apr 10;306(6883):983–987. doi: 10.1136/bmj.306.6883.983. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Simon J. A. Treating hypertension: the evidence from clinical trials. BMJ. 1996 Aug 24;313(7055):437–438. doi: 10.1136/bmj.313.7055.437. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Stern D. Management of hypertension in twelve Oxfordshire general practices. J R Coll Gen Pract. 1986 Dec;36(293):549–551. [PMC free article] [PubMed] [Google Scholar]
  28. Wen S. W., Kramer M. S., Hoey J., Hanley J. A., Usher R. H. Terminal digit preference, random error, and bias in routine clinical measurement of blood pressure. J Clin Epidemiol. 1993 Oct;46(10):1187–1193. doi: 10.1016/0895-4356(93)90118-k. [DOI] [PubMed] [Google Scholar]
  29. Wilber J. A., Barrow J. G. Hypertension--a community problem. Am J Med. 1972 May;52(5):653–663. doi: 10.1016/0002-9343(72)90055-1. [DOI] [PubMed] [Google Scholar]
  30. Wingfield D., Pierce M., Feher M. Blood pressure measurement in the community: do guidelines help? J Hum Hypertens. 1996 Dec;10(12):805–809. [PubMed] [Google Scholar]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners

RESOURCES