Quality statement 2: Investigations for target organ damage

Quality statement

People with newly diagnosed hypertension receive investigations for target organ damage within 1 month of diagnosis.

Rationale

Assessment of target organ damage can alert the clinician to possible secondary causes of hypertension, some of which are potentially life threatening and some that may be amenable to potentially curative interventions. It can also support the clinician to decide the appropriate blood pressure threshold at which to consider drug therapy for the treatment of hypertension.

Quality measure

Structure: Evidence of local arrangements for people with newly diagnosed hypertension to receive all investigations for target organ damage within 1 month of diagnosis.

Process: Proportion of people with newly diagnosed hypertension who receive all investigations for target organ damage within 1 month of diagnosis.

Numerator – the number of people in the denominator who receive all investigations for target organ damage within 1 month of diagnosis.

Denominator – the number of people with newly diagnosed hypertension.

What the quality statement means for each audience

Service providers ensure systems are in place for people with newly diagnosed hypertension to receive all investigations for target organ damage within 1 month of diagnosis.

Healthcare professionals carry out all investigations for target organ damage for people with newly diagnosed hypertension within 1 month of diagnosis.

Commissioners ensure they commission services that carry out all investigations for target organ damage for people with newly diagnosed hypertension within 1 month of diagnosis.

People with newly diagnosed hypertension (high blood pressure) receive tests within 1 month of being diagnosed to check for any damage to organs such as their eyes, heart or kidneys.

Source guidance

Hypertension in adults: diagnosis and management (2019) NICE guideline NG136, recommendations 1.2.5 and 1.3.3

Data source

Structure: Local data collection.

Process: Local data collection.

Definitions

Investigations for target organ damage

For all people with hypertension, healthcare professionals should offer to:

  • test for the presence of protein in the urine by sending a urine sample for estimation of the albumin:creatinine ratio and test for haematuria using a reagent strip

  • take a blood sample to measure glycated haemoglobin (HbA1C), electrolytes, creatinine, estimated glomerular filtration rate, serum total cholesterol and HDL cholesterol

  • examine the fundi for the presence of hypertensive retinopathy

  • arrange for a 12-lead electrocardiograph to be performed.

[NICE's guideline on hypertension in adults, recommendation 1.3.3]

Target organ damage

Damage to organs such as the heart, brain, kidneys and eyes. Examples are left ventricular hypertrophy, chronic kidney disease, hypertensive retinopathy or increased urine albumin:creatinine ratio.

[NICE's guideline on hypertension in adults, terms used in this guideline]