Quality standard
Quality statement 1: Diagnosis – ambulatory blood pressure monitoring
Quality statement 1: Diagnosis – ambulatory blood pressure monitoring
Quality statement
Adults with suspected hypertension have ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM) 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 adults 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. HBPM may be used if ABPM is unsuitable or the person is unable to tolerate ABPM, for example, for adults with particular learning or physical disabilities.
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 a new diagnosis of hypertension whose diagnosis has been confirmed by ABPM or HBPM.
Numerator – the number of adults in the denominator whose diagnosis has been confirmed by ABPM or HBPM.
Denominator – the number of adults with a new diagnosis of hypertension.
Data source: Data can be collected from information recorded on GP systems.
What the quality statement means for different audiences
Service providers (such as general practices and community pharmacies) ensure that systems are in place to offer ABPM and HBPM to confirm a diagnosis of hypertension.
Healthcare professionals (such as GPs, practice nurses or community pharmacists) offer ABPM or HBPM to confirm a diagnosis of hypertension.
Commissioners ensure that they commission services that offer ABPM and HBPM to confirm a diagnosis of hypertension.
Adults with suspected hypertension (high blood pressure) have ambulatory blood pressure monitoring (which involves wearing a blood pressure monitor during their normal waking hours) or home blood pressure monitoring to confirm whether they have hypertension.
Source guidance
Hypertension in adults: diagnosis and management. NICE guideline NG136 (2019, updated 2023), recommendations 1.2.3 and 1.2.4
Definitions of terms used in this quality statement
Suspected hypertension
Clinic blood pressure between 140/90 mmHg and 180/120 mmHg without a confirmed diagnosis of hypertension. [NICE's guideline on hypertension in adults, recommendation 1.2.3]
Ambulatory blood pressure monitoring (ABPM)
ABPM involves a cuff and bladder connected to electronic sensors that 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, section 5.7.3]
Home blood pressure monitoring (HBPM)
HBPM devices are oscillometric and measure blood pressure on the upper arm, the wrist or the finger. Home monitoring potentially offers some similar benefits to ABPM. Frequent measurement produces average values that may be more reproducible and reliable than traditional clinic measurement. To confirm a diagnosis of hypertension, blood pressure should be measured twice daily, ideally in the morning and evening and continued for at least 4 days, ideally 7 days. For each blood pressure recording, 2 consecutive measures should be taken at least 1 minute apart when seated. [NICE's 2011 full guideline on hypertension in adults, section 5.7.3, and NICE's guideline on hypertension in adults, recommendation 1.2.7]