Monitoring and follow-up

Monitoring treatment and blood pressure targets

For guidance on blood pressure control in people with chronic kidney disease guideline on chronic kidney disease in adults.

Use clinic blood pressure measurements to monitor the response to lifestyle changes or drug treatment in people with hypertension

Measure standing as well as seated blood pressure in people with hypertension and:

• with type 2 diabetes or
• with symptoms of postural hypotension or
• aged 80 and over
  
  
• in people with a significant postural drop or symptoms of postural hypotension, treat to a blood pressure target based on standing blood pressure.

Advise people with hypertension who choose to self-monitor their blood pressure to use HBPM.

Consider ABPM or HBPM, in addition to clinic blood pressure measurements, for people with hypertension identified as having a white-coat effect or masked hypertension (in which clinic and non-clinic blood pressure results are conflicting). Be aware that the corresponding measurements for ABPM and HBPM are 5 mmHg lower than for clinic measurements

For people who choose to use HBPM, provide:

• training and advice on using home blood pressure monitors information about what to do if they are not achieving their target blood pressure.

Be aware that the corresponding measurements for HBPM are 5 mmHg lower than for clinic measurements

Reduce clinic blood pressure to below 140/90 mmHg and maintain that level in adults with hypertension aged under 80

Reduce clinic blood pressure to below 150/90 mmHg and maintain that level in adults with hypertension aged 80 and over. Use clinical judgement for people with frailty or multimorbidity

When using ABPM or HBPM to monitor the response to treatment in adults with hypertension, use the average blood pressure level taken during the person's usual waking hours (see recommendations 1.2.6 and 1.2.7). Reduce and maintain blood pressure at the following levels:

• below 135/85 mmHg for adults aged under 80
• below 145/85 mmHg for adults aged 80 and over.

Guidance relating to follow up of hypertension patients suggests (2)

• frequency of follow up for treated patients with adequate blood pressure control depends on factors including variability and severity of blood pressure, complexity of the treatment regimen, and compliance
• when treatment and blood pressure are stable then six monthly review is probably sufficient
• the routine for follow up visits, at which trained nurse practitioners have an important role, should include:
  • measure blood pressure and weight
  • inquire about general health and side effects
  • reinforce lifestyle advice and adherence to drug therapy
  • test for proteinuria annually.

Reference:

1. NICE (August 2019). Hypertension in adults: diagnosis and management
2. Williams B, Poulter NR, Brown MJ, Davis M, McInnes GT, Potter JF, et al. Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society, 2004-BHS IV. J Hum Hypertens 2004;18: 139-85