The diagnosis/exclusion of hypertension can often be assisted by carrying out additional BP monitoring.
Ambulatory Blood Pressure (ABPM)
| Definitions | Indications |
|---|---|
| ABPM records a series of BP measurements, usually set at 30-minute intervals | Increasingly, to confirm hypertension diagnosis and whether drug treatment is needed (NICE, 2011); suspected ‘white coat’ hypertension (‘false’ BP stress response to clinic setting); or unusual BP variability. Felt to more accurately predict end-organ damage (e.g. left ventricular hypertrophy, chronic kidney disease) (SIGN, 2007) . Average value of at least 14 readings during the waking period used for hypertension diagnosis (NICE, 2011). |
Home Blood Pressure Monitoring (HBPM)
| Definitions | Indications |
|---|---|
| Series of twice daily home BP recordings, over 7 days. Morning and evening measurements recommended, each taking average of 2 consecutive readings, 1 minute apart (NICE, 2011) | Used as alternative to ABPM. Useful if ABPM not tolerated or impractical (NICE, 2011). Requires a validated monitor suitable for home recording (details from British Hypertension Society website) |
Diagnostic thresholds for hypertension using both ABPM and HBPM
Treat stage 1 hypertension, in line with guidance, if further assessment shows the following: left ventricular hypertrophy on the ECG; protein in urine; or retinal changes (like microscopic changes in the arterioles). Otherwise, monitor and ensure arrangements are made to review the patient (e.g. when are you arranging to see them again). Always treat stage 2 in line with guidance.
| Stage 1 hypertension: 135/85mmHg or higher | Stage 2 hypertension: 150/95mmHg or higher |
|---|
Pulse point
Remember both stages require in-depth lifestyle advice as part of treatment! This is a chance to do an assessment of their future risk of developing cardiac disease. You will learn more about primary prevention of cardiac disease in module 2.
See NICE guidance for fuller definitions of hypertension stages for recommended further assessment and treatment for each stage.
Page last reviewed: 21 May 2020
