Next steps

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 their 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 pharmacy should offer the person 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 used.

ABPM: This involves fitting the person with a validated ABPM monitor 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 made and onward referral to the GP practice is needed.

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 person with a ‘blood pressure diary’ to record their readings in, and to agree a method and timescale for returning them to the pharmacy. This could be in paper format or via a digital platform, depending on what is available and on personal preference. 

When reviewing the results, the readings from day one should be discarded. The mean of all other readings should then be used to calculate the person’s HBPM. If this reading is >135/85mmHg, a diagnosis of hypertension is made and onward referral to a GP practice is needed.

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