High blood pressure (BP) is usually asymptomatic, except where there is a Hypertensive Emergency (Headaches, blurred vision etc.).
Whilst waiting for Ambulatory Blood Pressure Monitoring (ABPM) / Home Blood Pressure Monitoring (HBPM) undertake the following investigations for Cardiovascular Disease assessment / prevention:
If hypertension is NOT diagnosed and there is evidence of target organ damage such as left ventricular hypertrophy, albuminuria or proteinuria: investigate alternative causes of the target organ damage. (See Investigations section)
Primary or essential hypertension (primary, cause unknown) accounts for the majority of cases, particularly in the older patient.
Consider treating immediately if blood pressure (BP) in clinic is more than or equal to 180/110 mm Hg
Otherwise, consider after results of Ambulatory Blood Pressure Monitoring (ABPM) or Home Blood Pressure Monitoring (HBPM), blood tests and cardiovascular risk assessment are available.
Hypertension treatment should be discussed with patients- discuss individual CVD Risk and preferences for treatment, including no treatment, and explain risks and benefits before starting drug treatment –
Offer Treatment if Stage 1 Hypertension plus -
Choosing antihypertensive drug treatment -
Newly diagnosed Hypertensives – Community Pharmacy service
Consider using your local Community Pharmacy for ‘NMS’ New Medicines Service which most pharmacists offer with any new antihypertensive. This can help with monitoring of side effects and compliance. Suggest putting ‘NMS please’ on prescription to remind pharmacy to offer it.
Monitor response to treatment - in Primary Care Hypertension clinic/Annual review – consider using Health Care Assistant’s (HCA’s) / Practice Nurses (PN’s), GP Pharmacist or Community Pharmacy Medicine Use Review Service if not already doing so.
Review risk factors for cardiovascular disease - delivered as part of an annual review of care to address modifiable risk factors.
Further Ambulatory Blood Pressure Monitoring (ABPM) / Home Blood Pressure Monitoring (HBPM) may be needed to avoid overtreatment due to 'white coat hypertension'.
A list of validated BP monitoring devices is available on the British & Irish Hypertension Society’s website: Healthcare professionals using monitoring devices should be trained to use the device and interpret data. Please follow the resource link below to the website.
If Hypertension is not responsive to above treatments consider -
Refer same day if:
Health Care Assistant's (HCA's)
Refer to GP if:
Refer to specialist if -