GPAtlas🧭 When to suspect
Hypertension is usually asymptomatic – the “silent killer”. It is most often found through opportunistic screening or as an incidental clinic reading, rather than because the patient feels unwell.
Suspect it when:
• A clinic blood pressure (BP) is ≥ 140/90 mmHg, or
• There is evidence of hypertension-mediated organ damage (left ventricular hypertrophy, chronic kidney disease, retinopathy or raised urine albumin:creatinine ratio).
A single high clinic reading is not a diagnosis.
• A discrepancy of more than 20/10 mmHg between clinic and out-of-office readings (the white-coat effect) is common.
• Confirm the diagnosis with ambulatory BP monitoring (ABPM) – or home BP monitoring (HBPM) if ABPM is unsuitable or not tolerated – unless the clinic BP is in the severe range.
• A clinic BP in the severe range (≥ 180/120 mmHg) warrants more urgent action.
• Adults with a normal BP should be screened at least every 5 years.
| Category | Clinic BP | ABPM/HBPM average |
|---|---|---|
| Normal or not diagnosed | < 140/90 mmHg | – |
| Stage 1 | 140/90 – 159/99 mmHg | 135/85 – 149/94 mmHg |
| Stage 2 | ≥ 160/100 (and < 180/120) mmHg | ≥ 150/95 mmHg |
| Stage 3 (severe) | Systolic ≥ 180 or diastolic ≥ 120 mmHg | Confirm urgently or same-day review if indicated |
Raise suspicion of a secondary cause in anyone aged under 40, in resistant hypertension, or where the history points to it:
• Paroxysmal headache, palpitations, pallor and sweating (phaeochromocytoma).
• Muscle weakness or hypokalaemia (primary hyperaldosteronism or Conn’s).
• Snoring and daytime somnolence (obstructive sleep apnoea).
• Renal disease.
Always review BP-raising agents – NSAIDs, corticosteroids, combined oral contraceptives, venlafaxine, decongestants and liquorice.
Source: NICE NG136
🔒 Sign up free to read the full topic
You're viewing a free preview. Create a free account to unlock the rest.
Sign up free →Sample topics are open to everyone in the Free Sample Bundle.