Initial steps

There are many opportunities to identify people who may have high blood pressure. For a patient in a community pharmacy, the first step will be to take blood pressure readings (although the readings in isolation do not confirm a diagnosis).

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

Always check that the person’s pulse is regular prior to taking the blood pressure reading. This is important both to ensure that the monitor used is appropriate for obtaining accurate blood pressure readings and to identify the need to refer to the GP for further evaluation if an irregular pulse is found (this could indicate possible atrial fibrillation).

When taking a blood pressure reading, it is important to ensure there is a relaxed, quiet environment and that the correct cuff size is used. If the cuff size is too small, this may under-estimate the blood pressure and, conversely, if the blood pressure cuff is too large, the blood pressure may be over-estimated.

Blood pressure in both arms should be measured. 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, use the arm with the higher reading. 

If blood pressure 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), take a third measurement. Record the lower of the last two measurements as the clinic blood pressure. 

The next step depends on the results of these readings. There may be situations where the blood pressure is markedly raised. The pharmacy 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.