What happens next?

For people with low or normal blood pressure readings, no further action is needed at this stage other than, where appropriate, to offer lifestyle advice and suggest a time frame for the person’s blood pressure to be re-measured.

 For people with raised clinic blood pressure (>140/90-180/129mmHg) who do not meet the criteria for urgent or same-day referral to a GP, the pharmacist should offer them the opportunity to confirm the diagnosis of hypertension. The options are ambulatory blood pressure monitoring (ABPM) or alternatively, if ABPM is unsuitable or the person is unable to tolerate it, home blood pressure monitoring (HBPM) may be carried out.

ABPM: This involves fitting the person with a validated ABPM device to record their blood pressure. Readings are taken at least every 30 minutes during the person’s usual waking hours. An average of at least 14 daytime readings is needed to confirm a diagnosis of hypertension. If this result is >135/85mmHg, a diagnosis of hypertension is confirmed and the person should be referred to their GP.

HBPM: When using HBPM the person should record two consecutive blood pressure measurements, taken at least one minute apart, twice a day (ideally morning and evening) with the person seated. The readings should be taken for at least four and ideally seven days. 

It is useful to provide the patient with a blood pressure diary to record the readings and to agree the method and timescale for returning to the pharmacy. The diary could be in paper format or a digital platform. 

The pharmacist should then review the results to determine the mean blood pressure. Readings from day one should be discarded. The mean of all other readings is used to calculate the person’s HBPM-measured blood pressure. 

If this reading is >135/85mmHg, the diagnosis of hypertension is confirmed and the patient must be referred to their GP for further investigation. 

People should be told that if they record consecutive blood pressure readings over a given threshold (e.g. >170/115mmHg), they should contact their GP practice for an urgent same-day review.

Currently, a patient would need to purchase his or her own BP monitor or community pharmacies need to have a process in place to lend one out. It is possible in future that a blood pressure monitor can be supplied direct to a patient – this is currently being rolled out in England to support home monitoring for people already diagnosed with hypertension (BP@Home programme).

Reflection exercise

High blood pressure is thought to affect one in four adults in the UK. How would you approach someone to offer a blood pressure measurement check?