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A number of patients may be wrongly coded in this group, for example patients who have had one-off high blood pressure readings or women who have been hypertensive in pregnancy.
The NICE clinical guideline on Hypertension (CG127) uses the following definitions:
Stage 1 hypertension - clinic blood pressure is 140/90 mmHg or higher and subsequent ambulatory blood pressure monitoring (ABPM) daytime average or home blood pressure monitoring (HBPM) average blood pressure is 135/85 mmHg or higher.
Stage 2 hypertension - clinic blood pressure is 160/100 mmHg or higher and subsequent ABPM daytime average or HBPM average blood pressure is 150/95 mmHg or higher.
Severe hypertension Clinic systolic blood pressure is 180 mmHg or higher or clinic diastolic blood pressure is 110 mmHg or higher.
Elevated blood pressure readings of greater than 140/90 on three separate occasions have generally been used to confirm sustained high blood pressure. However, the recently updated NICE clinical guideline on Hypertension now recommends the use of ambulatory blood pressure monitoring (ABPM) to confirm the diagnosis of hypertension, particularly if a clinic blood pressure reading is 140/90 mmHg or higher.
The use of ABPM to confirm the diagnosis of hypertension is a significant change in practice and may take time to be integrated into routine clinical practice.
For patients aged 39 mor under with stage 1 hypertension and no evidence of target organ damage, CVD, renal disease or diabetes, the NICE guideline recommends that practitioners consider seeking specialist evaluation of secondary causes of hypertension and a more detailed assessment of potential target organ damage. This is because 10-year cardiovascular risk assessments can underestimate the lifetime risk of cardiovascular events in these patients.
NICE public health guidance 25. Prevention of CVD 2011
See indicator wording for requirement criteria.
The contractor may be required by the NHS CB to discuss their plans for ensuring that new diagnoses are confirmed using ABPM or HBPM as appropriate.
Prepared By Jean Keenan