• James P Sheppard, Kate Fletcher, Richard J McManus, and Jonathan Mant.
• Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
• Br J Gen Pract. 2014 Oct 1; 64 (627): e641e648e641-8.

BackgroundTreatment for uncomplicated stage 1 hypertension is recommended in most international guidelines but there is little evidence to indicate that therapy is beneficial.AimTo estimate the prevalence of this condition in an untreated population and the potential costs of initiating therapy in such patients.Design And SettingCross-sectional study of anonymised patient records in 19 general practices in the West Midlands, UK.MethodData relating to patient demographics, existing cardiovascular disease (CVD), and risk factors (blood pressure and cholesterol) were extracted from patient records. Patients with a blood pressure of 140/90-159/99 mmHg, no CVD, and <20% 10-year cardiovascular risk were classified as having uncomplicated stage 1 hypertension. Missing data were imputed. The prevalence of untreated, uncomplicated stage 1 hypertension was estimated using descriptive statistics and extrapolated using national data. The cost of achieving blood pressure control in this population was examined in a cost-impact analysis using published costs from previous studies.ResultsOf the 34 975 patients (aged 40-74 years) in this study, untreated, uncomplicated stage 1 hypertension was present in 2867 individuals (8.2%, 95% confidence interval [CI] = 7.9 to 8.5). This is equivalent to 1 892 519 patients in England and Wales, for whom the additional cost of controlling blood pressure, according to guidelines, was estimated at £106-229 million per annum, depending on the health professional delivering care.ConclusionUntreated, uncomplicated stage 1 hypertension is relatively common, affecting 1 in 12 patients aged 40-74 years in primary care. Current international guidelines and pay-for-performance targets, if followed, will incur significant costs for a patient benefit that is debatable.© British Journal of General Practice 2014.

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