Diagnosis and treatment

How it’s diagnosed

If a clinic reading is between 140/90 and 180/120, NICE says you should be offered a 24-hour ambulatory monitor (ABPM) to confirm it. If that isn’t suitable, you should be offered home monitoring (HBPM) instead.

High blood pressure is confirmed when the clinic reading is 140/90 or higher and the average from the 24-hour monitor (daytime) or home readings is 135/85 or higher.

If you don’t have high blood pressure, NICE says it should be checked in clinic at least every 5 years, and possibly more often if it’s close to 140/90.

When medicine is offered

The NHS says a GP will usually prescribe medicine if your blood pressure is very high, if you’re at higher risk of problems such as a heart attack or stroke, or if it’s still high after healthy lifestyle changes. Most blood pressure medicines are tablets taken once a day, and you may need more than one.

In more detail, NICE recommends:

• Stage 2 (persistent): medicine plus lifestyle advice, at any age.
• Stage 1, under 80: discuss medicine if you have organ damage caused by blood pressure, heart or circulation disease, kidney disease, diabetes, or a 10-year cardiovascular risk of 10% or more.
• Stage 1, under 60 with a risk below 10%: medicine may be considered.
• Stage 1, over 80: medicine may be considered if the clinic reading is over 150/90.

The types of medicine

NICE uses a step-by-step approach, adding medicines if blood pressure stays high:

1. Step 1: an ACE inhibitor or an ARB (angiotensin II receptor blocker) for people with type 2 diabetes, or people under 55 who aren’t of Black African or African-Caribbean family origin. A calcium channel blocker (CCB) for people aged 55 or over, or of Black African or African-Caribbean family origin, who don’t have type 2 diabetes. A thiazide-like diuretic (“water tablet”) can be used if a CCB doesn’t suit.
2. Step 2: add a second medicine from a different group.
3. Step 3: an ACE inhibitor or ARB, plus a CCB, plus a thiazide-like diuretic.
4. Step 4: if blood pressure is still high, the readings are confirmed and other medicines may be considered, with specialist advice if needed.

An ACE inhibitor and an ARB should never be taken together. ACE inhibitors and ARBs shouldn’t be used in pregnancy, while breastfeeding or when planning a pregnancy unless absolutely necessary.

Target levels

Once you’re on treatment, NICE sets these targets:

ACR (albumin:creatinine ratio) is a urine test for kidney damage. People with type 2 diabetes have the same targets as everyone else. You should be offered a review at least once a year. Your GP may set a different target for you. You can enter your own target in your account settings.