TY - JOUR T1 - Impact of changes to national guidelines on hypertension related workload JF - British Journal of General Practice JO - Br J Gen Pract DO - 10.3399/bjgp21X714281 SP - bjgp21X714281 AU - Sarah Lay-Flurrie AU - James Sheppard AU - Richard J Stevens AU - Christian Mallen AU - Carl Heneghan AU - FD Richard Hobbs AU - Bryan Williams AU - Jonathan Mant AU - Richard McManus Y1 - 2020/12/14 UR - http://bjgp.org/content/early/2020/12/17/bjgp21X714281.abstract N2 - Background: In 2011, National Institute for Health and Care Excellence (NICE) guidelines recommended the routine use of out-of-office blood pressure (BP) monitoring for the diagnosis of hypertension. These changes were predicted to reduce unnecessary treatment costs and workload associated with misdiagnosis. Aim: To assess the impact of guideline change on rates of hypertension-related consultation in general practice. Design and Setting: Cohort study in adults registered with English general practices contributing to the Clinical Practice Research Datalink between 1/4/2006 and 31/3/2017. Method: The primary outcome was the rate of face-to-face, telephone and visit consultations related to hypertension with a GP or nurse. Age and sex standardized rates were analysed using interrupted time-series analysis. Results: In 3,937,191 adults (median follow-up = 4.2 years) there were 12,253,836 hypertension related consultations. The rate of hypertension related consultation was 71.0 per 100 person-years (95% CI 67.8 to 74.2) in April 2006, which remained flat prior to 2011. The introduction of the NICE hypertension guideline in 2011 was associated with a change in yearly trend (change in trend = -3.60 per 100 person-years, 95% CI -5.12 to -2.09). The rate of consultation subsequently decreased to 59.2 per 100 person-years (95% CI 56.5 to 61.8) in March 2017. These changes occurred around the time of diagnosis and persisted when accounting for wider trends in all consultations. Conclusion: Hypertension-related workload has declined in the last decade, in association with guideline changes. This is due to changes in workload at the time of diagnosis, rather than reductions in misdiagnosis. ER -