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'Referral advice' recommendation details

Hypertension

Guidance ID NICE 'referral advice' recommendation 'Referral advice' category
CG127 If the systolic blood pressure falls by 20 mmHg or more when the person is standing: -review medication -measure subsequent blood pressures with the person standing -consider referral to specialist care if symptoms of postural hypotension persist. Time frame Not Specified
CG127 Refer the person to specialist care the same day if they have: -accelerated hypertension, that is, blood pressure usually higher than 180/110 mmHg with signs of papilloedema and/or retinal haemorrhage or -suspected phaeochromocytoma (labile or postural hypotension, headache, palpitations, pallor and diaphoresis). Immediate
CG127 For people aged under 40 years with stage 1 hypertension and no evidence of target organ damage, cardiovascular disease, renal disease or diabetes, consider seeking specialist evaluation of secondary causes of hypertension and a more detailed assessment of potential target organ damage. Time frame Not Specified
CG127 If blood pressure remains uncontrolled with the optimal or maximum tolerated doses of four drugs, seek expert advice if it has not yet been obtained. Time frame Not Specified
CG127 Regard clinic blood pressure that remains higher than 140/90 mmHg after treatment with the optimal or best tolerated doses of an ACE inhibitor or an angiotensin II receptor blocker (ARB) plus a Calcium Channel blocekr (CCB) plus a diuretic as resistant hypertension, and consider adding a fourth antihypertensive drug and/or seeking expert advice. Time frame Not Specified
CG127 Consider the need for specialist investigations in people with signs and symptoms suggesting a secondary cause of hypertension. Time frame Not Specified

This page was last updated: 22 August 2012

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.