Quality statement 1: Diagnosis – ambulatory blood pressure monitoring

Quality statement

People with suspected hypertension are offered ambulatory blood pressure monitoring (ABPM) to confirm a diagnosis of hypertension.

Rationale

ABPM is the most accurate method for confirming a diagnosis of hypertension, and its use should reduce unnecessary treatment in people who do not have true hypertension. ABPM has also been shown to be superior to other methods of multiple blood pressure measurement for predicting blood pressure-related clinical events. 

Quality measure

Structure: Evidence of local arrangements to ensure people with suspected hypertension are offered ABPM to confirm a diagnosis of hypertension.

Process: Proportion of people with suspected hypertension who receive ABPM to confirm a diagnosis of hypertension.

Numerator – the number of people in the denominator who receive ABPM to confirm a diagnosis of hypertension.

Denominator – the number of people with suspected hypertension.

What the quality statement means for each audience

Service providers ensure systems are in place to offer ABPM to confirm a diagnosis of hypertension.

Healthcare professionals offer ABPM to confirm a diagnosis of hypertension.

Commissioners ensure they commission services that offer ABPM to confirm a diagnosis of hypertension.

People with suspected hypertension (high blood pressure) are offered ambulatory blood pressure monitoring (which involves wearing a blood pressure monitor during their normal waking hours) to confirm whether or not they have hypertension.

Source guidance

Hypertension in adults: diagnosis and management (2019) NICE guideline NG136, recommendation 1.2.3

Data source

Structure: Local data collection.

Process: Local data collection.

Definitions

Ambulatory blood pressure monitoring (ABPM)

ABPM involves a cuff and bladder connected to electronic sensors which detect changes in cuff pressure and allow blood pressure to be measured oscillometrically. Systolic and diastolic pressure readings are deduced from the shape of oscillometric pressure changes using an algorithm built into the measuring device. A patient's blood pressure can be automatically measured at repeated intervals throughout the day and night, while they continue routine activities. Systolic and diastolic pressure can be plotted over time, with most devices providing average day, night and 24-hour pressures. NICE recommends recording a daytime average to confirm diagnosis.

[NICE's 2011 full guideline on hypertension in adults]

Suspected hypertension

Clinic blood pressure of 140/90 mmHg or higher without a confirmed diagnosis of hypertension.

[NICE's guideline on hypertension in adults]

Equality and diversity considerations

ABPM may not be suitable for everyone, for example people with particular learning or physical disabilities. Some people may be unable to tolerate ABPM and some people may decline it.

Home blood pressure monitoring (HBPM) should be offered as an alternative to ABPM in such cases, in line with NICE's guideline on hypertension in adults, recommendation 1.2.4. If a person is unable to tolerate ABPM, HBPM is a suitable alternative to confirm the diagnosis of hypertension.