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Hypertension

Checked: 23-01-2021 by Vicky Ryan Next Review: 23-01-2022

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 Clinical Knowledge Summary - Hypertension (non- diabetic) guidelines - (September 2020) on the diagnosis and management of hypertension.

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.

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

Referral Guidance

24 Hour Ambulatory BP

If ambulatory blood pressure monitoring is not available in your practice then consider home monitoring.

Ambulatory BP monitoring is accessed via eRS to both UHB (please fill in this form) and NBT (please fill in this form) and submit via the Cardiology Monitoring RAS in eRS.

Specialist Hypertension Clinic

Patients who might benefit from referral include the following;

Patients <40 with ambulatory of home BP of >135/85
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)

Hypertension Clinics

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

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

NBT hypertension is managed within the general cardiology clinic accessed via eRS

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 - September 2020)

Please also see the flow diagram Assessment of Severe Hypertension in the Community for uncomplicated adults which gives clarification on when immediate /same day referral is required.

Hypertension in pregnancy

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

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.