A suite of resources is available to detect and manage Hypertension and to support Blood Pressure Care.
The following tools are available to detect patients with un-coded or possible Hypertension.
The following reports will help identify patients with Hypertension who may not been appropriately coded.
The searches are in CDRC Quality > Cardiovascular
|? Hypertension/BP 2.1 Casefinding – Potential Hypertension indicator but no HT code||Patients with a code to suggest hypertension (e.g. hypertension annual review) without a QoF hypertension code||The QoF and Contracting template will help to identify the codes (see example below)|
|? Hypertension/BP 2.2 Casefinding – Medication that might be for HT but no HT||Patients taking medication which might be for hypertension who don’t have an obvious indication for this.|
|? Hypertension/BP 2.3 Casefinding – ABPM>=135/85 and not appropriately coded||Patients with a home BP average reading >=135/85 (which defines hypertension) without a subsequent hypertension code.|
|? Drug to Diagnosis 004 – Betablocker without obvious indication||Also likely to detect other diagnoses such as hypertension, heart failure, SVT, CHD|
|? Drug to Diagnosis 005 – Calcium channel blocker without obvious indication||Also likely to detect other diagnoses such as hypertension, Raynauds, SVT, CHD|
|? Drug to Diagnosis 007 – RAS Drug without obvious indication||Also likely to detect other diagnoses such as CHD, diabetic kidney disease, heart failure, LVSD|
|? Drug to Diagnosis 009 – Thiazides without obvious indication|
From the Hypertension template, previous blood pressure readings, QoF hypertension codes and non-QoF possible indicators of Hypertension can be seen.
The following searches (CDRC Quality > Cardiovascular) identify people not currently on the Hypertension register, whose last blood pressure was high. Different thresholds are set to enable prioritisation of assessment:
- ? Hypertension/BP 1.1 Screening – Consider repeat BP Last BP >=140/90 #
- ? Hypertension/BP 1.2 Screening – Consider repeat BP Last BP >=150/90 #
- ? Hypertension/BP 1.3 Screening – Consider repeat BP Last BP >=160/100 #
- ? Hypertension/BP 1.4 Screening – Consider repeat BP Last BP >=170/105 #
These patients will be flagged with the raised BP icon (to the right of the GMS icon) if your unit has opted into (see ‘Hypertension Opt-in Resources’ below) the optional Hypertension Resources or Cardiovascular Resources
Consider inviting these patients for a follow up blood pressure or home blood pressure testing. Patients can be invited systematically using the searches or opportunistically using the patient status alert flag.
It might also be possible to direct them to local pharmacies taking part in the hypertension finding scheme.
The Hypertension CDRC template facilitates review of patients with hypertension.
The Hypertension template features:
- Information about estimated and actual BP targets with a link to the BP Target Setting template to record/update BP targets. QoF achievement is shown (this covers achievement for all BP related QoF indicators not just the hypertension domain).
- Recent blood pressure readings (of any type) and a link to the BP graph function.
- A panel which shows if the patient is on the hypertension register and specifically shows if the patient has stage 1 hypertension without end organ damage. Information about end organ damage is shown here. There are links to templates to add/remove patients from the hypertension register and to view and record information about End Organ Damage.
- A panel showing key lifestyle factors which contribute to hypertension. There is a link to the Core Data template to record lifestyle factors and deliver interventions / referrals. There is a link to patient information to manage blood pressure
The BP treatment panel shows current antihypertensive medication and will show prompts when applicable such as:
- Consider setting BP target
- Consider intensification of treatment
- Consider ACEi/A2RB when this is specifically indicated e.g. diabetic kidney disease
- Consider drug concordance when patients are not collecting antihypertensives.
There is a link to the BP Treatment template which shows the NICE pathway for treating raised blood pressure. There is also a link to record hypertension exception codes. The Scripts and BPs button will show previous antihypertensives along with BP readings making it easier to review progress with current and previous treatment.
There is a panel showing information and CVD risk and lipid lowering therapy with a link to the lipid template
There is space to record that the review has been completed along with any relevant comments. The most recent review (and any comments) are shown in the panel alongside.
The BP Target template shows estimated targets (NICE and QoF as these are not always aligned) and allows recording of patient specific targets. If a target is set which is not the default, it is helpful to record this as free text with the target – this free text will be displayed in the panel on the right.
The Hypertension End Organ Damage template shows relevant information.
Previous information about renal function/proteinuria/haematuria can be displayed by clicking the <Expand button
The last ECG can be viewed by right clicking on it and choosing View content.
The BP Treatment template provides guidance about how to treat blood pressure. The home page sets out BP targets, current treatment and the NICE pathway.
Other pages show:
- Guidance about when to start treatment
- Disease specific guidance
The following searches will help target patients for intervention, they can be found in the CDRC Quality > Cardiovascular folder
|? Hypertension/BP 3.1 Management – Consider setting personal target||Hypertension patients without a personal BP target||Consider setting a BP target|
|? Hypertension/BP 3.2 Management – Consider treatment intensification||Hypertensive patients who have not achieved the relevant NICE BP target or a personally set target||Consider patient review and intensification of treatment||Patients with stage 1 hypertension without end organ damage who are off treatment are not included Patients are not included if the last blood pressure was recorded in the last 6w allowing time for recent intervention to have an effect|
|? Hypertension/BP 3.21/.22 Management – Consider Treatment Intensification – Higher/Highest Priority||Patients in 3.2 with BP >20/10 or >30/15 higher than target|
|? Hypertension/BP 3.3 Management – Consider Poor Concordance||Hypertensive patients who do not appear to be collecting antihypertensives||Consider review of concordance|
|? Hypertension/BP 3.41/.42 Management – No BP check for 15M/18M||Hypertensive patients significantly overdue a BP check||Consider review|
|? Hypertension/BP 3.51/.52 Management – High/ Highest potential for intervention||Hypertensive patients with combinations of issues – BP above target, concordance, time since last BP||Consider review|
BP Detailed Blood Pressure Template
Blood pressure can be recorded on the Core Data Entry template or more detailed blood pressure information can be seen/recorded on the BP Detailed Blood Pressure template which be reached from the Core Data Entry template or added to existing toolbars or templates.
The BP Detailed Blood Pressure template has the following features
|Column 1||Column 2||Column 3|
|Space to record specific requirements for BP recording e.g. cuff size, which are to use/avoid||Most recent blood pressure monitoring comments|
|Link to BP Targets setting template||Current estimated NICE BP target Current QoF target Current patient specific target (if this has been set)||Indicator to describe current QoF performance regarding blood pressure (all QoF domains)|
|Link to BP Exceptions template|
|Space to record various clinic BPs||Most recent BP readings (all types)||Link to BP Graph which shows more detailed information about previous BP reading in data or graphical form|
|Relevant home blood pressure codes Link to a printable home BP record sheet Link to the Communication Annexe to send SMS or email links for a BP recording sheet. Link to an average calculator Space to record home or ambulatory BP||Relevant information about previous home and ambulatory BP readings and codes|
The Guidance page has information about recording blood pressure and diagnosing hypertension
The Resources page has links to professional resources and a button to link to patient resources
BP at Home
The following resources are available to support Blood Pressure at home.
Searches To Identify Relevant Patients
The following searches will help identify patients who might benefit from blood pressure measurements at home. CDRC Quality > Cardiovascular
Search 1.1 identifies patients who need BP management (hypertension, diabetes, CKD) who have not achieved the NICE target for their combination of risk factors, unless they have a target BP recorded that has been achieved. People with moderate or severe frailty, care home residents and palliative care stages B/C/D are excluded.
Search 1.11 identifies patients in 1.1 who have had a record (in the past 12 months) of home BP measurement, referral for home BP, home BP not indicated, home BP declined.
The other searches use the same criteria but identify patients at increasing levels of risk, based on factors such as last BP level, comorbidities, history of engagement, concordance.
Use the BP Detailed Blood Pressure template to record relevant information and values
Use the PIL Hypertension and Blood Pressure template for providing patient information.
Patient Information Leaflets
This Patient Information template has links to useful patient resources – both weblinks and some printable resources for use from face to face consultations.
There is a link to the Communication Annexe which makes it easy to send information electronically to patients. This also allows the patient to send completed BP sheets back to the practice.
Hypertension Opt-In Resources
The following resources are available to support Hypertension / Blood Pressure management / QoF Performance. Because these resources trigger automatically they are not enabled automatically at each unit. To activate the resources email NECSU.firstname.lastname@example.org
If the resources are activated at your unit the following report will return a number similar to your list size:
The Hypertension Bundle of opt-in resources includes:
|Resource||Trigger||Action||Automatic Trigger Limited To|
|Raised BP PSA (icon)||Displays for patients not on the hypertension register with raised BP||Consider repeat BP or home BP||Units using CVD or hypertension resources|
|BP Target Protocol||Will trigger if the patient’s estimated BP target changes e.g. at new hypertension diagnosis||Consider adding a BP target||Units using CVD or hypertension resources|
To request activation of the hypertension system at your unit email NECSU.CDRC@nhs.net All the resources will be activate as a bundle. Any individual component can be deactivated locally if no longer required.
Units can check to see if the resources are activated by seeing if this search returns roughly the number of patients registered at that unit.
The following searches allow units to assess their performance with respect to blood pressure management. These searches cover people with any condition for which BP control is recommended – CKD, diabetes, hypertension and stroke/TIA