Quality standard
Quality statement 6: Referral to a specialist for adults with resistant hypertension
Quality statement 6: Referral to a specialist for adults with resistant hypertension
Quality statement
Adults with resistant hypertension who are receiving 4 antihypertensive drugs and whose blood pressure remains uncontrolled are referred for specialist assessment.
Rationale
Adults with resistant hypertension will usually be at high risk of cardiovascular disease. Specialist assessment and evaluation supports management of their condition.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Process
Proportion of adults with resistant hypertension who are receiving 4 antihypertensive drugs and whose blood pressure remains uncontrolled who are referred for specialist assessment.
Numerator – the number of adults in the denominator who are referred for specialist assessment.
Denominator – the number of adults with resistant hypertension who are receiving 4 antihypertensive drugs and whose blood pressure remains uncontrolled.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.
What the quality statement means for different audiences
Service providers (such as general practices) ensure that local arrangements are in place for adults with resistant hypertension who are receiving 4 antihypertensive drugs and whose blood pressure remains uncontrolled to be referred for specialist assessment.
Healthcare professionals (such as GPs) refer adults with resistant hypertension who are receiving 4 antihypertensive drugs and whose blood pressure remains uncontrolled for specialist assessment.
Commissioners ensure that they commission services that refer adults with resistant hypertension who are receiving 4 antihypertensive drugs and whose blood pressure remains uncontrolled for specialist assessment.
Adults with resistant hypertension (high blood pressure that is difficult to control) who are receiving 4 antihypertensive drugs (drugs to treat high blood pressure) and whose blood pressure is still high are referred for specialist assessment.
Source guidance
Hypertension in adults: diagnosis and management. NICE guideline NG136 (2019, updated 2023), recommendations 1.4.46, 1.4.48 and 1.4.52
Definitions of terms used in this quality statement
Resistant hypertension
Hypertension that is not controlled in adults taking the optimal tolerated doses of an angiotensin-converting enzyme inhibitor or an angiotensin II receptor blocker plus a calcium-channel blocker and a thiazide-like diuretic. [NICE's guideline on hypertension in adults, recommendation 1.4.46]