Initial steps

For patients identified in pharmacy, the first step is a blood pressure reading(s) taken in a clinic setting (i.e. in the pharmacy). This may indicate that the person has hypertension – although any reading(s) in isolation will not confirm a diagnosis. 

It is important to ensure that readings are taken correctly. Community pharmacies should ensure that validated and appropriately re-calibrated equipment is used. The British and Irish Hypertension Society produces a list of validated machines for both home and specialist use.  

Pharmacists should always check that the person’s pulse is regular before taking a reading. This is important both to ensure that the monitor used is appropriate to obtain an accurate blood pressure reading and to identify any need to refer to a GP for further evaluation if an irregular pulse is found (suggesting possible atrial fibrillation).

There should be a relaxed, quiet environment in which to take the person’s blood pressure and the correct cuff size should always be used. If the cuff size is too small this may underestimate the blood pressure and, conversely, if the blood pressure cuff is too large the blood pressure reading may be overestimated.

When considering a diagnosis of hypertension, measure the blood pressure using both arms. If the difference in readings between arms is more than 15mmHg, repeat the measurements. If the difference in readings remains more than 15mmHg on the second measurement, take subsequent measures using the arm with the higher reading. 

If blood pressure measured in the pharmacy is 140/90mmHg or higher, a second measurement should be taken. If the second measurement is substantially different from the first (a difference in systolic blood pressure of more than 10mmHg), a third measurement should be taken and the lower of the last two measurements recorded as the clinic blood pressure. 

The next steps depend on the results of these readings. There may be situations where the blood pressure is markedly raised and community pharmacies should have a standard operating procedure (SOP) in place for onward referral to the person’s GP, including any criteria for urgent and same-day referral.