Summary

Blood pressure is a measure of the force that your heart uses to pump blood around your body. We need a certain level of blood pressure to be healthy and this ‘normal’ blood pressure, when measured by clinicians, falls between 90/60 mmHg and 140/90 mmHg.

When blood pressure is consistently higher than normal, this is called Hypertension. People with hypertension are at greater risk of heart failure, strokes, and other conditions.

Hypertension generally does not have any noticeable symptoms, which is why it’s important to test blood pressure on a regular basis.

Care pathway

This pathway is designed to assess hypertension status in patients in order to effectively manage high blood pressure and prevent further complications of hypertension.

1️⃣ Book the appointment

1. We are using a combination of platforms / tools / teams to book patients in correctly with minimal manual effort. If @Louis Williams hasn’t already been in touch, check out the page to find our Monthly Summary plans or reach out to him to find out what you should be doing:
• If we’re using Hippo Labs, log into app.hippolabs.co.uk to find patient lists (see for more information)
• If we’re using Hero Health or AccuRX, @Louis Williams will send your team manual excel recall lists

2. Call the patient to book an appointment with HCA F2F and Pharmacist (if patient has not had a medication review in the past 12 months)

Appointments should be booked one after another where possible, or as close as possible on the same day. It doesn’t matter in which order the patient see these clinicians in.

Explain what the appointment is for, advise them that they’ll have a blood test on the day, and they they must produce a fresh urine sample on the day of their appointment

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About urine samples

2️⃣ Patient arrives for appointment

1. Record that the patient has arrived in the appointment book
2. Allow the patient a moment to relax before asking to capture data on height, weight, blood pressure, smoking status, and alcohol status (if possible) and add to patient’s EMIS record
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How-to guides

3. Collect urine sample from patient

3️⃣ HCA review

1. Open the clinical template: ‘Penrose Health - Hypertension’ and complete ‘BP control’, ‘HCA review’ and ‘BP @ home’ pages
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Methods of blood pressure measurement
2. Draw bloods (for HbA1c, lipid profile and renal profile) and ask patient to produce urine sample if not already handed to Reception (for ACR)
3. Perform a foot check
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How-to guide
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All patients should have a foot check (not just those who are diabetic)
4. Pulse check → If abnormal, organise an ECG (see 📈ECGs for further details)
5. Make appropriate referrals as below:
• For BMI, refer to 🍎The Lambeth Healthy Weight Hub, 🍎Up! Up! Lewisham (Tier 2 Weight Management), 🍎NHS Tier 2 Weight Management Service or 🍎NHS Tier 3 Healthy Weight Programme as appropriate
• For smoking cessation, refer to 🚭Southwark Stop Smoking Service, 🚭Lewisham Stop Smoking Service or 🚭Lambeth Stop Smoking Service
1. Book a follow-up appointment to assess for 🦵Peripheral arterial disease (PAD)
2. For moderate/high risk foot check, follow ‘Diabetes Foot Care Pathway’ on DXS, and refer to 🦶Community Foot Health (Podiatry) or 🦶Multi-disciplinary Foot (MDFT) Clinics

4️⃣ Medication review

1. Open the clinical template: ‘Penrose Health - Hypertension’ and complete ‘Medication review’ page
2. See the following resources to review guidelines for care and prescribing meds:
• Hypertension Guidance for Primary Care SE London 2022
• New Hypertension Drugs Update from UK NICE guideline 2019 in 5 steps

5️⃣ Check & triage results

1. Review pathology results, and action as per the 🔬Lab Reports (Path Links) page.