A 55 year old gentleman moves house and registers with a new GP, a health check is arranged and his blood pressure is found to be 145/95. Which of the following most accurately describes this gentleman?

A) He has normal blood pressure, no action should be taken.
B) He is hypertensive and should be started on medication.
C) He is hypertensive and should be advised on life style changes.
D) He is hypertensive and should be offered ambulatory blood pressure monitoring.
E) He is hypotensive and should be started on medication.




The answer is D. The care pathway for hypertension can be found on page 6 of this PDF http://www.nice.org.uk/nicemedia/live/13561/56015/56015.pdf

Although this blood pressure would indicate hypertension 24 hour blood pressure monitoring [aka ambulatory blood pressure monitoring aka ABPM] is offered to confirm the diagnosis. If the patient is unable to tolerate this [after all you have to wear a blood pressure cuff for 24 hours with it inflating and deflating throughout the 24 hours!] then home blood pressure monitoring [aka HBPM] should be offered.

If hypertension is confirmed then we have two options:

ABPM/HBPM of over 135/85 and target organ damage present or 10 year cardiovascular risk >20% offer antihypertensive drug treatment. If the patient is younger than 40 years then consider a specialist referral.

ABPM/HBPM of over 150/95 [known as stage 2 hypertension] then offer antihypertensive drug treatment.

Always offer lifestyle intervention and offer patient education and interventions to support adherence to treatment.