The Oakwood Surgery
Clinical Protocols
Hypertension
24 hour and Home BP monitoring
QoF topic
http://publications.nice.org.uk/hypertension-cg127/key-priorities-for-implementation
Author
Created
Reviewed
Review Date
Dr Dean Eggitt
March 2013
March 2014
March 2015
The practice has one 24 hour blood pressure monitor and numerous home blood pressure
monitors to loan to patients. These have been purchased to assist in making the diagnosis of
hypertension, when white coat hypertension is suspected or where it is more convenient for
the patient to monitor their blood pressure at home. The machines are suitable for the
following circumstances



Initial diagnosis of hypertension
Annual review of a patient with known hypertension where white coat hypertension is
known or suspected
Review of a patient’s blood pressure where treatment for the hypertension is not yet
stable, but the patient is also suspected to have an element of white coat hypertension.
This protocol relates to patients above 40 years of age with no predisposing disease states. If
hypertension is suspected in a patient less than 40 years of age, then they should be seen by a
GP.
24 hour (ambulatory) blood pressure monitoring (ABPM)
 Minimum of 14 readings 30 minutes apart.
Home blood pressure monitoring (HBPM)
 At the first appointment with the health care assistant, inform the patient of their
duties to protect the property of the practice and ask the patient to sign the practice
agreement before loan of the machine.
 Teach the patient how to measure their own blood pressure using the electronic
sphygmomanometer on loan from the practice
 Provide the patient with a chart for recording their blood pressure on. This needs to
be completed three times per day for 7 days.
 Book an appointment for the return of the BP machine at one week
 When the patient returns with the machine do not forget to take the record of the
blood pressure from them.
 The health care assistant should then calculate from the form, the average systolic and
diastolic blood pressures, complete this information on the form, and code this on the
computer under
o Average systolic home blood pressure (246d)
o Average diastolic home blood pressure (246c)
 The completed BP form needs to be placed in the Duty Dr post basket.
 The Duty Dr will then consider what action needs to be taken regarding the blood
pressure.
Stages of hypertension
Stage 1
> 140/90 in clinic
AND ABPM daytime average is >135/85
Stage 2
>160/100 in clinic
AND ABPM daytime average is > 150/95
Severe
> 180 / > 110
***Requires immediate treatment***