Clinical Learning
Clinical 7: Hypertension in adults
Accurate diagnosis, cardiovascular risk assessment, postural blood pressure, treatment principles and review using NICE NG136.
Clinical safety: Use current guidance, local policy and patient-specific judgement.
Learning objectives
• Measure and confirm hypertension accurately • Recognise when ABPM or HBPM is needed • Assess cardiovascular risk and target-organ damage • Recognise postural hypotension and its clinical implications • Apply treatment principles while accounting for frailty and multimorbidity
Clinical safety note
Severe hypertension, acute target-organ symptoms and pregnancy require different or urgent pathways. This module does not replace current NICE algorithms, BNF prescribing information or local escalation arrangements.
Confirming the diagnosis
Measure blood pressure carefully and in both arms at first assessment. If clinic BP is 140/90 mmHg or higher but below the severe range requiring urgent consideration, NICE recommends ambulatory blood pressure monitoring to confirm the diagnosis, or home monitoring if ABPM is unsuitable. The diagnosis is confirmed when clinic BP is at least 140/90 mmHg and the daytime ABPM or HBPM average is at least 135/85 mmHg.
Postural hypotension
In people with symptoms or relevant risk, measure blood pressure lying or seated and again after standing. A fall of at least 20 mmHg systolic or 10 mmHg diastolic after standing for at least 1 minute should prompt review of likely causes, including medicines, and subsequent BP targets/measurements should use standing values where appropriate.
Risk and target-organ assessment
Assess cardiovascular risk and look for target-organ damage. NICE recommends urine ACR and haematuria testing, HbA1c, electrolytes, creatinine/eGFR, lipids, fundal examination and a 12-lead ECG as part of the assessment for people with hypertension.
Treatment principles
Lifestyle advice is relevant at all stages. Drug treatment depends on BP stage, age, cardiovascular risk, target-organ damage, renal disease, diabetes and established cardiovascular disease. Frailty and multimorbidity require clinical judgement and shared decision making. Use the live NICE algorithm and current BNF for exact drug choices, contraindications and monitoring.
