Hypertension

It is important to note that Appt includes care needs for hypertension that may not be directly mentioned or mandated in UK guidelines, but may be considered for these patients on account of the potential clinical benefits of undertaking these tests and checks. As a practice, it is important that you decide what is best for your clinical practice and patient population. If there are care needs included within Appt’s care coordination service that you do not wish to offer your patient population, we can customise your targets accordingly – just get in touch.

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Annual care needs:

Blood pressure

Rationale:

Annual blood pressure checks are essential to ensure effective management and prevent complications. Regular monitoring helps assess whether treatment is working, allows for medication adjustments, and detects any increases in blood pressure early.

Guideline:

NICE Guideline 136: Hypertension in adults: diagnosis and management

U&Es

Rationale:

‍NICE guideline NG136, it does not explicitly recommend annual renal function testing for all hypertensive patients. However, it emphasises assessing for target organ damage at diagnosis, which includes evaluating renal function.

While routine annual renal function testing isn't explicitly mandated for all hypertensive patients, monitoring may be appropriate in certain cohorts, such as those with CKD, diabetes, or those on medications affecting renal function, such as ACEs, ARBs and diuretics.

On balance, Appt's clinical team has included annual renal function tests as an appropriate part of an annual review for hypertensive patients.

Guideline:

NICE Guideline 136: Hypertension in adults: diagnosis and management

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HbA1c

Rationale:

‍Patients with hypertension are at increased risk of developing type 2 diabetes, and while no universal guideline recommends annual HbA1c testing specifically for hypertensive patients, key organisations highlight the importance of regular screening.

The American Diabetes Association (ADA) suggests screening adults aged 35 and older for diabetes, with more frequent testing for those with additional risk factors like hypertension. The U.S. Preventive Services Task Force (USPSTF) similarly recommends screening adults aged 35–70 who are overweight or obese, noting that hypertension increases diabetes risk and may warrant more frequent checks.  

These guidelines support individualised screening intervals based on risk, making annual HbA1c testing a reasonable consideration for hypertensive patients, particularly if other risk factors are present.

Guidelines:

ADA Standards of Care 2023

USPSTF Recommendation Statement on Diabetes Screening

Lipid profile

Rationale:

‍NICE guidelines for managing hypertension recommend measuring total cholesterol levels in individuals diagnosed with hypertension as part of a cardiovascular risk assessment. This is especially important for individuals with additional risk factors such as smoking, obesity, or a family history of heart disease. While annual testing is not explicitly mentioned, regular lipid checks are encouraged to monitor for atherosclerotic cardiovascular disease risk.

Guideline:

NICE Guideline 136: Hypertension in adults: diagnosis and management

uACR

Rationale:

‍The KDIGO 2012 Clinical Practice Guidelines for the Evaluation and Management of Chronic Kidney Disease strongly recommend the use of uACR for early detection of kidney damage in hypertensive patients. Incorporating uACR testing into the annual hypertension review ensures timely identification of kidney damage, enabling early intervention to prevent progression to more severe stages of CKD. Given the high incidence of CKD in hypertensive patients, routine uACR checks should be considered as part of comprehensive hypertension management, improving outcomes by allowing for early treatment adjustments and reducing long-term health risks.

Guideline:

KDIGO 2012 Clinical Practice Guidelines for the Evaluation and Management of Chronic Kidney Disease (CKD)

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Annual hypertension review

Rationale:

‍An annual hypertension review is essential to monitor blood pressure, optimise treatment and prevent complications. Hypertension is a major risk factor for stroke, heart attack, kidney disease, and heart failure. Regular reviews help track blood pressure trends, assess cardiovascular risks, review medications, screen for complications like kidney disease, and support lifestyle changes to improve overall health.

Guidelines:

NICE Guideline 136: Hypertension in adults: diagnosis and management

European Society of Cardiology (ESC) 2018 Guidelines