REMEDY : BNSSG referral pathways

Hypertension - UHB & NBT

Checked: 23-07-2018 by Rob.Adams Next Review: 23-07-2019

Prinicples of Management

High blood pressure or hypertension rarely has noticeable symptoms. But if untreated, it increases the risk of serious problems such as heart attacks and strokes. More than one in four adults in the UK have high blood pressure, although many won't realise it.  Please refer to the NICE guidelines on the diagnosis and management of hypertension.

Diagnosis should be confirmed by ambulatory blood pressure monitoring (see below) or home blood pressure monitoring.

If referral is being considered you may wish to request advice via the consultant led Cardiology Advice & Guidance Service via E-Referral.

Referral Guidance

24 Hour Ambulatory BP

If ambulatory blood pressure monitoring is not available in your practice then consider home monitoring (see NICE guidelines on diagnosis of hypertension) .

Ambulatory BP monitoring is available via direct referral to UHB or via e-Referral to NBT. 

Specialist Hypertension Clinic

Patients who might benefit from referral include the following;

  • Patients <40 with ambulatory of home BP of >135/85

  • Patients with signs of symptoms suggestive of a secondary cause of hypertension 

  • Patients with drug resistant hypertension (uncontrolled BP despite treatment with optimal doses of >3 antihypertensive agents) 

  • Patients with drug intolerant hypertension (uncontrolled BP due to multiple drug intolerances)

Hypertension Clinics

UHB run a specialist Hypertension Referral Centre.  For full details please see the BHI Clinical Service Webpage.

NBT also have hypertension clinics accessed via e-referral (Cardiology NOS)

Red Flags

Refer the person for same-day specialist care if they have:

- Blood pressure higher than 180/110 mmHg with signs of papilloedema and/or retinal haemorrhage (accelerated hypertension).

- Suspected phaeochromocytoma (labile or postural hypotension, headache, palpitations, pallor, and diaphoresis).