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The National Institute for Health and Care Excellence (NICE) guideline for the management of hypertension has attracted considerable attention for its tightening of treatment thresholds and targets. Of particular interest is its recommendation to offer antihypertensive drug treatment to adults under the age of 80 years who have persistent stage 1 hypertension and an estimated 10-year risk of cardiovascular disease of 10% or more.1 Antihypertensive drug treatment should also be considered for those aged over 80 years with a clinic blood pressure of over 150/90 mm Hg. Perhaps of greater significance are the changes to the hypertension indicator in the Quality and Outcomes Framework (QOF) for primary care in England.2 The thresholds for payment are 40%–77% for achieving a blood pressure of 140/90 mm Hg or lower in patients aged below 80 years, …
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