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Hypertension

About

What is covered

This interactive flowchart covers the clinical management of primary hypertension in adults.
High blood pressure (hypertension) is one of the most important preventable causes of premature morbidity and mortality in the UK. Hypertension is a major risk factor for ischaemic and haemorrhagic stroke, myocardial infarction, heart failure, chronic kidney disease, cognitive decline and premature death. Untreated hypertension is usually associated with a progressive rise in blood pressure. The vascular and renal damage that this may cause can culminate in a treatment-resistant state.
Blood pressure is normally distributed in the population and there is no natural cut-off point above which 'hypertension' definitively exists and below which it does not. The risk associated with increasing blood pressure is continuous, with each 2 mmHg rise in systolic blood pressure associated with a 7% increased risk of mortality from ischaemic heart disease and a 10% increased risk of mortality from stroke. Hypertension is remarkably common in the UK and the prevalence is strongly influenced by age. In any individual person, systolic and/or diastolic blood pressures may be elevated. Diastolic pressure is more commonly elevated in people younger than 50. With ageing, systolic hypertension becomes a more significant problem, as a result of progressive stiffening and loss of compliance of larger arteries. At least one quarter of adults (and more than half of those older than 60) have high blood pressure.

Updates

Updates to this interactive flowchart

27 October 2015 Implanting a baroreceptor stimulation device for resistant hypertension (NICE interventional procedures guidance 533) added to step 4 resistant hypertension.
21 August 2015 Interactive flowchart restructured and summarised recommendations replaced with full recommendations.
20 March 2013 Hypertension in adults (NICE quality standard 28) added.
15 January 2013 WatchBP Home A for opportunistically detecting atrial fibrillation during diagnosis and monitoring of hypertension (NICE medical technologies guidance 13) added to measuring blood pressure.

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart 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.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Short Text

Everything NICE has said on managing hypertension in adults in an interactive flowchart

What is covered

This interactive flowchart covers the clinical management of primary hypertension in adults.
High blood pressure (hypertension) is one of the most important preventable causes of premature morbidity and mortality in the UK. Hypertension is a major risk factor for ischaemic and haemorrhagic stroke, myocardial infarction, heart failure, chronic kidney disease, cognitive decline and premature death. Untreated hypertension is usually associated with a progressive rise in blood pressure. The vascular and renal damage that this may cause can culminate in a treatment-resistant state.
Blood pressure is normally distributed in the population and there is no natural cut-off point above which 'hypertension' definitively exists and below which it does not. The risk associated with increasing blood pressure is continuous, with each 2 mmHg rise in systolic blood pressure associated with a 7% increased risk of mortality from ischaemic heart disease and a 10% increased risk of mortality from stroke. Hypertension is remarkably common in the UK and the prevalence is strongly influenced by age. In any individual person, systolic and/or diastolic blood pressures may be elevated. Diastolic pressure is more commonly elevated in people younger than 50. With ageing, systolic hypertension becomes a more significant problem, as a result of progressive stiffening and loss of compliance of larger arteries. At least one quarter of adults (and more than half of those older than 60) have high blood pressure.

Updates

Updates to this interactive flowchart

27 October 2015 Implanting a baroreceptor stimulation device for resistant hypertension (NICE interventional procedures guidance 533) added to step 4 resistant hypertension.
21 August 2015 Interactive flowchart restructured and summarised recommendations replaced with full recommendations.
20 March 2013 Hypertension in adults (NICE quality standard 28) added.
15 January 2013 WatchBP Home A for opportunistically detecting atrial fibrillation during diagnosis and monitoring of hypertension (NICE medical technologies guidance 13) added to measuring blood pressure.

Sources

NICE guidance and other sources used to create this interactive flowchart.
Hypertension in adults: diagnosis and management (2011 updated 2016) NICE guideline CG127
Implanting a baroreceptor stimulation device for resistant hypertension (2015) NICE interventional procedures guidance 533
Hypertension in adults (2013 updated 2015) NICE quality standard 28

Quality standards

Quality statements

Diagnosis – ambulatory blood pressure monitoring

This quality statement is taken from the hypertension in adults quality standard. The quality standard defines clinical best practice for hypertension in adults and should be read in full.

Quality statement

People with suspected hypertension are offered ambulatory blood pressure monitoring (ABPM) to confirm a diagnosis of hypertension.

Rationale

ABPM is the most accurate method for confirming a diagnosis of hypertension, and its use should reduce unnecessary treatment in people who do not have true hypertension. ABPM has also been shown to be superior to other methods of multiple blood pressure measurement for predicting blood pressure-related clinical events.

Quality measure

Structure
Evidence of local arrangements to ensure people with suspected hypertension are offered ABPM to confirm a diagnosis of hypertension.
Process
Proportion of people with suspected hypertension who receive ABPM to confirm a diagnosis of hypertension.
Numerator – the number of people in the denominator who receive ABPM to confirm a diagnosis of hypertension.
Denominator – the number of people with suspected hypertension.

Description of what the quality statement means for each audience

Service providers ensure systems are in place to offer ABPM to confirm a diagnosis of hypertension.
Healthcare professionals offer ABPM to confirm a diagnosis of hypertension.
Commissioners ensure they commission services that offer ABPM to confirm a diagnosis of hypertension.
People with suspected hypertension (high blood pressure) are offered ambulatory blood pressure monitoring (which involves wearing a blood pressure monitor during their normal waking hours) to confirm whether or not they have hypertension.

Source clinical guideline references

NICE clinical guideline 127 recommendation 1.2.3 (key priority for implementation).

Data source

Structure
Local data collection.
Process
Local data collection. Contained within NICE clinical guideline 127 clinical audit tool: diagnosing hypertension, criterion 1.

Definitions

Ambulatory blood pressure monitoring (ABPM)
Clinical guideline 127 Hypertension: full guideline: Ambulatory blood pressure monitoring (ABPM) involves a cuff and bladder connected to electronic sensors which detect changes in cuff pressure and allow blood pressure to be measured oscillometrically. Systolic and diastolic pressure readings are deduced from the shape of oscillometric pressure changes using an algorithm built into the measuring device. A patient's blood pressure can be automatically measured at repeated intervals throughout the day and night, while they continue routine activities. Systolic and diastolic pressure can be plotted over time, with most devices providing average day, night and 24-hour pressures. NICE recommends recording a daytime average to confirm diagnosis.
Suspected hypertension
NICE clinical guideline 127 recommendation 1.2.3 describes suspected hypertension as clinic blood pressure of 140/90 mmHg or higher without a confirmed diagnosis of hypertension.

Equality and diversity considerations

ABPM may not be suitable for everyone, for example people with particular learning or physical disabilities. Some people may be unable to tolerate ABPM and some people may decline it.
Home blood pressure monitoring should be offered as an alternative to ABPM in such cases, in line with NICE clinical guideline 127 recommendation 1.2.4. If a person is unable to tolerate ABPM, home blood pressure monitoring (HBPM) is a suitable alternative to confirm the diagnosis of hypertension.

Investigations for target organ damage

This quality statement is taken from the hypertension in adults quality standard. The quality standard defines clinical best practice for hypertension in adults and should be read in full.

Quality statement

People with newly diagnosed hypertension receive investigations for target organ damage within 1 month of diagnosis.

Rationale

Assessment of target organ damage can alert the clinician to possible secondary causes of hypertension, some of which are potentially life threatening and some that may be amenable to potentially curative interventions. It can also support the clinician to decide the appropriate blood pressure threshold at which to consider drug therapy for the treatment of hypertension.

Quality measure

Structure
Evidence of local arrangements for people with newly diagnosed hypertension to receive all investigations for target organ damage within 1 month of diagnosis.
Process
Proportion of people with newly diagnosed hypertension who receive all investigations for target organ damage within 1 month of diagnosis.
Numerator – the number of people in the denominator who receive all investigations for target organ damage within 1 month of diagnosis.
Denominator – the number of people with newly diagnosed hypertension.

Description of what the quality statement means for each audience

Service providers ensure systems are in place for people with newly diagnosed hypertension to receive all investigations for target organ damage within 1 month of diagnosis.
Healthcare professionals carry out all investigations for target organ damage for people with newly diagnosed hypertension within 1 month of diagnosis.
Commissioners ensure they commission services that carry out all investigations for target organ damage for people with newly diagnosed hypertension within 1 month of diagnosis.
People with newly diagnosed hypertension (high blood pressure) receive tests within 1 month of being diagnosed to check for any damage to organs such as their eyes, heart or kidneys.

Source clinical guideline references

NICE clinical guideline 127 recommendations 1.2.6 and 1.3.3.

Data source

Structure
Local data collection.
Process
Local data collection. Contained within NICE clinical guideline 127 clinical audit tool: diagnosing hypertension, criterion 3.

Definitions

Investigations for target organ damage
NICE clinical guideline 127 recommendation 1.3.3 recommends that for all people with hypertension, healthcare professionals should offer to:
  • test for the presence of protein in the urine by sending a urine sample for estimation of the albumin:creatinine ratio and test for haematuria using a reagent strip
  • take a blood sample to measure plasma glucose, electrolytes, creatinine, estimated glomerular filtration rate, serum total cholesterol and HDL cholesterol
  • examine the fundi for the presence of hypertensive retinopathy
  • arrange for a 12-lead electrocardiograph to be performed.
Target organ damage
NICE clinical guideline 127 recommendation 1.2.6 lists left ventricular hypertrophy, chronic kidney disease and hypertensive retinopathy as examples of target organ damage.

Statin therapy

This quality statement is taken from the hypertension in adults quality standard. The quality standard defines clinical best practice for hypertension in adults and should be read in full.

Quality statement

Quality statement 3 has been replaced by quality statements on primary and secondary prevention of cardiovascular disease in cardiovascular risk assessment and lipid modification (NICE quality standard 100).

Blood pressure targets

This quality statement is taken from the hypertension in adults quality standard. The quality standard defines clinical best practice for hypertension in adults and should be read in full.

Quality statement

People with treated hypertension have a clinic blood pressure target set to below 140/90 mmHg if aged under 80 years, or below 150/90 mmHg if aged 80 years and over.

Rationale

Hypertension is associated with a higher risk of cardiovascular events. Setting blood pressure to recommended levels aims to promote primary and secondary prevention of cardiovascular disease, and to lower the risk of cardiovascular events.

Quality measure

Structure
a) Evidence of local arrangements to ensure people aged under 80 years with treated hypertension have a clinic blood pressure target set to below 140/90 mmHg.
b) Evidence of local arrangements to ensure people aged 80 years and over with treated hypertension have a clinic blood pressure target set to below 150/90 mmHg.
Outcome
People with treated hypertension whose target blood pressure is achieved.

Description of what the quality statement means for each audience

Service providers ensure systems are in place for people aged under 80 years with treated hypertension to have a clinic blood pressure target set to below 140/90 mmHg, and for people aged 80 years and over with treated hypertension to have a clinic blood pressure target set to below 150/90 mmHg.
Healthcare professionals ensure that people aged under 80 years with treated hypertension have a clinic blood pressure target set to below 140/90 mmHg, and people aged 80 years and over with treated hypertension have a clinic blood pressure target set to below 150/90 mmHg.
Commissioners ensure they commission services that have arrangements for people aged under 80 years with treated hypertension to have a clinic blood pressure target set to below 140/90 mmHg, and for people aged 80 years and over with treated hypertension to have a clinic blood pressure target set to below 150/90 mmHg.
People who are receiving treatment for hypertension (high blood pressure) have a target clinic blood pressure (blood pressure measured in their GP practice or clinic) below 140/90 mmHg if they are aged under 80 years, or a clinic blood pressure below 150/90 mmHg if they are aged 80 years or over.

Source clinical guideline references

NICE clinical guideline 127 recommendations 1.5.5 and 1.5.6.

Data source

Structure
a) and b) Local data collection.
Outcome
Quality and Outcomes Framework (QOF) indicator HYP002:The percentage of patients with hypertension in whom the last blood pressure reading (measured in the preceding 9 months) is 150/90 mmHg or less.
Quality and Outcomes Framework (QOF) indicator HYP003:The percentage of patients aged 79 and under with hypertension in whom the last blood pressure reading (measured in the preceding 9 months) is 140/90 mmHg or less.

Definitions

Clinic blood pressure
Clinic blood pressure refers to blood pressure measured in the clinic.
For a clinic blood pressure of 140/90 mmHg, the corresponding ambulatory blood pressure monitoring (ABPM) daytime average or home blood pressure monitoring (HBPM) average blood pressure is 135/85 mmHg.
For a clinic blood pressure of 160/100 mmHg or higher, the corresponding ABPM daytime average or HBPM average blood pressure is 150/95 mmHg or higher.
Treated hypertension
Treated hypertension includes treatment with antihypertensive drugs.

Equality and diversity considerations

Targets are based on evidence of safe practice. A person aged 80 years or over with treated hypertension would not have a target clinic blood pressure of 150/90 mmHg if their blood pressure was already treated to below this threshold.

Review of cardiovascular disease risk factors

This quality statement is taken from the hypertension in adults quality standard. The quality standard defines clinical best practice for hypertension in adults and should be read in full.

Quality statement

People with hypertension are offered a review of risk factors for cardiovascular disease annually.

Rationale

People’s blood pressure and cardiovascular disease risk will increase over time. A review of risk factors for cardiovascular disease delivered as part of an annual review of care should support identification of increased risk and provide an opportunity to address modifiable risk factors.

Quality measure

Structure
Evidence of local arrangements to ensure people with hypertension are offered a review of risk factors for cardiovascular disease annually.
Process
Proportion of people who have had hypertension for 12 months or longer who have had a review of risk factors for cardiovascular disease within the past 12 months.
Numerator – the number of people in the denominator who have had a review of risk factors for cardiovascular disease within the past 12 months.
Denominator – the number of people who have had hypertension for 12 months or longer who do not have established cardiovascular disease.

Description of what the quality statement means for each audience

Service providers ensure systems are in place to offer people with hypertension a review of risk factors for cardiovascular disease annually.
Healthcare professionals offer people with hypertension a review of risk factors for cardiovascular disease annually.
Commissioners ensure they commission services that offer people with hypertension a review of risk factors for cardiovascular disease annually.
People with hypertension (high blood pressure) are offered a review of risk factors for cardiovascular disease annually.

Source clinical guideline references

NICE clinical guideline 127 recommendation 1.7.3.

Data source

Structure
Local data collection.
Process
Quality and Outcomes Framework (QOF) indicator CVD-PP02: The percentage of patients diagnosed with hypertension (diagnosed on or after 1 April 2009) who are given lifestyle advice in the preceding 12 months for: smoking cessation, safe alcohol consumption and healthy diet.
Quality and Outcomes Framework (QOF) indicator SMOK005: The percentage of patients with any or any combination of the following conditions: CHD, PAD, stroke or TIA, hypertension, diabetes, COPD, CKD, asthma, schizophrenia, bipolar affective disorder or other psychoses who are recorded as current smokers who have a record of an offer of support and treatment within the preceding 12 months?

Definitions

Annual review of care
NICE clinical guideline 127 recommendation 1.7.3 recommends that an annual review of care should be provided to monitor blood pressure, provide people with support and discuss their lifestyle, symptoms and medication.
Review of risk factors for cardiovascular disease
Review of risk factors for cardiovascular disease could include:
  • smoking status
  • alcohol consumption
  • blood pressure
  • body mass index or other measure of obesity
  • total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides
  • blood glucose
  • renal function
  • liver function (transaminases) if receiving statins
  • heart rate and rhythm (pulse measurement).
(adapted from NICE clinical guideline 67 recommendation 1.4.2).
Blood pressure should be measured more frequently than annually for patients who need more frequent monitoring.

Referral to a specialist for people with resistant hypertension

This quality statement is taken from the hypertension in adults quality standard. The quality standard defines clinical best practice for hypertension in adults and should be read in full.

Quality statement

People with resistant hypertension who are receiving 4 antihypertensive drugs and whose blood pressure remains uncontrolled are referred for specialist assessment.

Rationale

People with resistant hypertension will usually be at high risk of cardiovascular disease. Specialist assessment and evaluation supports management of their condition.

Quality measure

Structure
Evidence of local arrangements for people with resistant hypertension who are receiving 4 antihypertensive drugs and whose blood pressure remains uncontrolled to be referred for specialist assessment.
Process
Proportion of people with resistant hypertension who are receiving 4 antihypertensive drugs and whose blood pressure remains uncontrolled who are referred for specialist assessment.
Numerator – the number of people in the denominator who are referred for specialist assessment.
Denominator – the number of people with resistant hypertension who are receiving 4 antihypertensive drugs and whose blood pressure remains uncontrolled.

Description of what the quality statement means for each audience

Service providers ensure local arrangements are in place for people with resistant hypertension who are receiving 4 antihypertensive drugs and whose blood pressure remains uncontrolled to be referred for specialist assessment.
Healthcare professionals refer people with resistant hypertension who are receiving 4 antihypertensive drugs and whose blood pressure remains uncontrolled for specialist assessment.
Commissioners ensure they commission services that refer people with resistant hypertension who are receiving 4 antihypertensive drugs and whose blood pressure remains uncontrolled for specialist assessment.
People with resistant hypertension (high blood pressure that is difficult to control) who are receiving 4 antihypertensive drugs (drugs to treat high blood pressure) and whose blood pressure is still high are referred for a specialist assessment.

Source clinical guideline references

NICE clinical guideline 127 recommendations 1.6.18 and 1.6.22.

Data source

Structure
Local data collection.
Process
Local data collection.

Definitions

Referral for specialist assessment
Referral should be to a healthcare professional, usually in secondary care, with specialist expertise in high blood pressure.
Resistant hypertension
NICE clinical guideline 127 recommendation 1.6.18 recommends that clinic blood pressure that remains higher than 140/90 mmHg despite step 3 treatment with the optimal or best tolerated doses of an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (ARB) plus a calcium-channel blocker (CCB) plus a diuretic should be regarded as resistant hypertension. People aged 80 years and over are considered to have resistant hypertension if their clinic blood pressure remains higher than 150/90 mmHg despite optimal or best tolerated doses of step 3 treatment.
Recommendation 1.6.22 recommends that expert advice should be sought if blood pressure remains uncontrolled with step 4 treatment of optimal or maximum tolerated doses of 4 drugs if expert advice has not yet been obtained.

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Information for the public

NICE has written information for the public on each of the following topics.

Pathway information

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart 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.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Supporting information

Glossary

angiotensin-converting enzyme inhibitor
angiotensin II receptor blocker
calcium-channel blocker
ambulatory blood pressure monitoring
estimated glomerular filtration rate
home blood pressure monitoring
clinic systolic blood pressure is 180 mmHg or higher or clinic diastolic blood pressure is 110 mmHg or higher
clinic blood pressure 140/90 mmHg or higher and subsequent ambulatory blood pressure monitoring daytime average or home blood pressure monitoring average blood pressure 135/85 mmHg or higher
clinic blood pressure 160/100 mmHg or higher and subsequent ambulatory blood pressure monitoring daytime average or home blood pressure monitoring average blood pressure 150/95 mmHg or higher
a discrepancy of more than 20/10 mmHg between clinic and average daytime ambulatory blood pressure monitoring or average home blood pressure monitoring measurements at the time of diagnosis

Paths in this pathway

Pathway created: August 2011 Last updated: July 2017

© NICE 2017

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