NICE published updated guidelines for the management of hypertension in 2019. This builds on the significant guidelines released in 2011 that recommended:
ABPM is the gold standard and should be offered first-line to confirm the diagnosis of hypertension. This approach helps identify white coat hypertension and provides a more accurate assessment of cardiovascular risk than clinic readings alone. ABPM involves at least two measurements per hour during waking hours, with at least 14 measurements averaged. The diagnosis of stage 1 hypertension would be confirmed if the daytime average is ≥135/85 mmHg.
HBPM involves twice-daily measurements for at least 4 days (ideally 7 days), with two consecutive readings at least 1 minute apart, discarding first-day measurements.
This becomes relevant later in some of the management decisions that NICE advocates.
| Stage | Criteria |
|---|---|
| Stage 1 hypertension | Clinic BP >= 140/90 mmHg and subsequent ABPM daytime average or HBPM average BP >= 135/85 mmHg |
| Stage 2 hypertension | Clinic BP >= 160/100 mmHg and subsequent ABPM daytime average or HBPM average BP >= 150/95 mmHg |
| Severe hypertension | Clinic systolic BP >= 180 mmHg, or clinic diastolic BP >= 120 mmHg |
Flow chart showing simplified schematic for diagnosis hypertension following NICE guidelines