Hypertension: Diagnosis

Key points

• NICE NG136: classify hypertension into stages and confirm with ambulatory (ABPM) or home (HBPM) blood pressure monitoring.
• Rationale: white-coat hypertension — clinic BP rises ~20 mmHg in some patients; ABPM prevents overdiagnosis and predicts CV events better than clinic readings.
• Stage 1: clinic ≥ 140/90 AND ABPM daytime/HBPM average ≥ 135/85 mmHg.
• Stage 2: clinic ≥ 160/100 AND ABPM/HBPM average ≥ 150/95 mmHg.
• Severe (stage 3): clinic BP ≥ 180/120 mmHg — assess for target organ damage; same-day specialist referral if retinal haemorrhage, papilloedema, or life-threatening symptoms.

Decision points in this pathway

• ABPM/HBPM average ≥ 135/85?
• Clinic ≥ 160/100 with ABPM/HBPM ≥ 150/95?

The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.