Introduction and overview

Introduction and overview


Hypertension (high blood pressure) is one of the most important preventable causes of premature morbidity and mortality in the UK. It increases the risk of atrial fibrillation and is a major risk factor for stroke (ischaemic and haemorrhagic), myocardial infarction, heart failure, chronic kidney disease, cognitive decline and premature death. Raised blood pressure is one of the three main modifiable risk factors for cardiovascular disease, which account for 80% of all cases of premature coronary heart disease (CHD).

This quality standard covers the management of primary hypertension in adults, including diagnosis and investigations, treatment to reduce risk of cardiovascular disease, monitoring of treatment efficacy, and specialist referral. For more information see the scope for this quality standard.

NICE quality standards describe high-priority areas for quality improvement in a defined care or service area. Each standard consists of a prioritised set of specific, concise and measurable statements. They draw on existing guidance, which provides an underpinning, comprehensive set of recommendations, and are designed to support the measurement of improvement. The quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following frameworks:

The table below shows the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving:

NHS outcomes framework 2013–14

Domain1: Preventing people from dying prematurely

Overarching indicators

1a Potential years of life lost (PYLL) from causes considered amenable to healthcare

1b Life expectancy at 75 i males ii females

Improvement areas

Reducing premature mortality from the major causes of death

1.1 Under 75 mortality rate for cardiovascular disease

Domain 2: Enhancing quality of life for people with long-term conditions

Overarching indicator

2 Health-related quality of life for people with long-term conditions

Improvement areas

Ensuring people feel supported to manage their condition

2.1 Proportion of people feeling supported to manage their condition

Improving functional ability in people with long-term conditions

2.2 Employment of people with long-term conditions

Reducing time spent in hospital by people with long-term conditions

2.3i Unplanned hospitalisation for chronic ambulatory care sensitive conditions (adults)

Public health outcomes framework 2013–16

Domain 1: Improving the wider determinants of health


Improvements against wider factors that affect health and wellbeing and health inequalities


1.8 Employment for those with a long-term health condition including those with a learning difficulty/disability or mental illness

1.9 Sickness absence rate

Domain 4: Healthcare public health and preventing premature mortality


Reduced numbers of people living with preventable ill health and people dying prematurely, while reducing the gap between communities


4.4 Mortality from all cardiovascular diseases (including heart disease and stroke)

4.13 Health-related quality of life for older people (placeholder)


The quality standard for hypertension states that services should be commissioned from and coordinated across all relevant agencies encompassing the hypertension care pathway. A person-centred approach to provision of services is fundamental in delivering high-quality care to adults with hypertension.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should cross refer across the library of NICE quality standards when designing high-quality services.

Patients, service users and carers may use the quality standard to find out about the quality of care they should expect to receive; support asking questions about the care they receive; and to make a choice between providers of social care services.

The quality standard should be read in the context of national and local guidelines on training and competencies. All health and social care professionals involved in assessing, caring for and treating adults with hypertension should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard.