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Hypertension

Checked: 29-01-2025 by Vicky Ryan Next Review: 28-01-2025

Overview

High blood pressure or hypertension rarely has noticeable symptoms. But if untreated, it increases the risk of serious problems such as heart attacks and strokes. More than one in four adults in the UK have high blood pressure, although many won't realise it. Please refer to the guidelines in the Cardiovascular System section of the BNSSG Formulary below:

BNSSG Guidelines for Investigation and Management of Hypertension in Adults

Diagnosis

Diagnosis should be confirmed by ambulatory blood pressure monitoring* (see below) or home blood pressure monitoring or by the community pharmacy hypertension case finding service.

*Except if SBP ≥180 mmHg OR DBP ≥120 mmHg on 3 readings same day (stage 3 hypertension) - see guideline above or Red Flag section below.

Community pharmacy NHSE hypertension finding service

Community pharmacies can now provide blood pressure monitoring services to support identification of hypertensive patients and reviews of existing patients as part of the nationally commissioned hypertension case-finding (HCF) service. Currently, more than 95% of pharmacies in BNSSG can offer this service and there is a map indicating the status of each, with "live" pharmacies depicted in green.

Referrals can be made by asking patients to attend a pharmacy offering the service, explaining that they have been sent by their GP practice for a blood pressure test.

Community pharmacies can do both clinic BP readings and ABPM readings and all the results will be shared with the patient’s registered GP.

Aide Memoire Contraception And Hypertension Services

Who to Refer

24 Hour Ambulatory BP

If ambulatory blood pressure monitoring is not available in your practice then consider home monitoring or community pharmacy hypertension finding service (see above).

Ambulatory BP monitoring can also be accessed via eRS referral to either:

UHBW - please complete the ICB UHB Hypertension Ambulatory form (also available as an EMIS template) and submit via the Cardiology Monitoring RAS- BRI or,
NBT - please complete the ICB NBT Cardiology Monitoring Request form (also available as an EMIS template) and submit via the Cardiology Monitoring Triage Service (RAS).

Specialist Hypertension Clinic

Patients who might benefit from referral include the following;

Patients <40 years with office BP of ≥140/90 mmHg AND ambulatory or home BP of ≥135/85 mmHg
Patients with signs of symptoms suggestive of a secondary cause of hypertension
Patients with drug resistant hypertension (uncontrolled BP despite treatment with optimal doses of >3 antihypertensive agents)
Patients with drug intolerant hypertension (uncontrolled BP due to multiple drug intolerances)

Red Flags

Refer the person for same-day specialist care if they have:

A clinic blood pressure of 180/120 mmHg and higher with:
- Signs of retinal haemorrhage and/or papilloedema (accelerated hypertension) or
- Life-threatening symptoms, such as new onset confusion, chest pain, signs of heart failure, or acute kidney injury.
Suspected phaeochromocytoma, for example labile or postural hypotension, headache, palpitations, pallor, abdominal pain, or diaphoresis.

(Clinical Knowledge Summaries: Hypertension- not diabetic)

What to do before referral

BNSSG Guidelines for Investigation and Management of Hypertension in Adults

Use the link above to access the guidelines in the BNSSG formulary which advises on management of patients in primary care and when to consider referral.

Referral

If advice is required prior to a referral, you may wish to request advice via the consultant led Cardiology Advice & Guidance Service via eRS.

UHBW has a specialist Hypertension Referral Centre and patients can be referred via eRS. For full details please see the BHI Clinical Service Webpage.

NBT does not have specialist hypertension clinics but patients can be referred to the general cardiology clinic accessed via eRS.

Hypertension in pregnancy

Please see the Hypertension in pregnancy guidelines in the Obstetrics section.

Resources

(1) Hypertension | CKS | NICE

Data and improvement tool

CVDPREVENT- this tool enables PCNs and practices to look at their data and compare to national targets.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.