Hypertension management in adult part 1

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 Hypertension::

Part 1:::

Instructions before measuring BP::

When measuring blood pressure in the clinic or in the home, standardise the environment and provide a relaxed, temperate setting, with the person quiet and seated, and their arm outstretched and supported. Use an appropriate cuff size for the person's arm.


people with symptoms of postural hypotension (falls or postural dizziness): • measure blood pressure with the person either supine or seated

• measure blood pressure again with the person standing for at least 1 minute before measurement.


Diagnosing hypertension::


When considering a diagnosis of hypertension, measure blood pressure in both arms:

  • If the difference in readings between arms is more than 15 mmHg, repeat the measurements.

  • If the difference in readings between arms remains more than 15 mmHg on the second measurement, measure subsequent blood pressures in the arm with the higher reading. 


If blood pressure measured in the clinic is 140/90 mmHg or higher: • Take a second measurement during the consultation.

• If the second measurement is substantially different from the first, take a third measurement.

Record the lower of the last 2 measurements as the clinic blood pressure.


If clinic blood pressure is between 140/90 mmHg and 180/120 mmHg, offer ambulatory blood pressure monitoring (ABPM) to confirm the diagnosis of hypertension. 


If ABPM is unsuitable or the person is unable to tolerate it, offer home blood pressure monitoring (HBPM) to confirm the diagnosis of hypertension.


When using ABPM to confirm a diagnosis of hypertension, ensure that at least 2 measurements per hour are taken during the person's usual waking hours (for example, between 08:00 and 22:00). Use the average value of at least 14 measurements taken during the person's usual waking hours to confirm a diagnosis of hypertension. 


 When using HBPM to confirm a diagnosis of hypertension, ensure that:

• for each blood pressure recording, 2 consecutive measurements are taken, at least 1 minute apart and with the person seated and

• blood pressure is recorded twice daily, ideally in the morning and evening and • blood pressure recording continues for at least 4 days, ideally for 7 days.

Discard the measurements taken on the first day and use the average value of all the remaining measurements to confirm a diagnosis of hypertension.


Confirm diagnosis of hypertension in people with a: • clinic blood pressure of 140/90 mmHg or higher and • ABPM daytime average or HBPM average of 135/85 mmHg or higher. 


If hypertension is not diagnosed but there is evidence of target organ damage, consider carrying out investigations for alternative causes of the target organ damage.


 If hypertension is not diagnosed, measure the person's clinic blood pressure at least every 5 years subsequently, and consider measuring it more frequently if the person's clinic blood pressure is close to 140/90 mmHg.


Source:: NICE guidance


By: Dr. Manilal Biswas

SSMC (২০১২-১৩)

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