Quality standard

Quality statement 2: Investigations for target organ damage

Quality statement 2: Investigations for target organ damage

Quality statement

Adults with newly diagnosed hypertension receive investigations for target organ damage within 1 month of diagnosis.

Rationale

Assessment of target organ damage can alert the clinician to possible secondary causes of hypertension, some of which are potentially life threatening and some may be amenable to potentially curative interventions. It can also support the clinician to decide the appropriate blood pressure threshold at which to consider drug therapy for the treatment of hypertension.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Process

Proportion of adults with newly diagnosed hypertension who receive all investigations for target organ damage within 1 month of diagnosis.

Numerator – the number of adults in the denominator who receive all investigations for target organ damage within 1 month of diagnosis.

Denominator – the number of adults with newly diagnosed hypertension.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.

What the quality statement means for different audiences

Service providers (such as general practices) ensure that systems are in place for adults with newly diagnosed hypertension to receive all investigations for target organ damage within 1 month of diagnosis.

Healthcare professionals (such as GPs and practice nurses) carry out all investigations for target organ damage for adults with newly diagnosed hypertension within 1 month of diagnosis.

Commissioners ensure that they commission services that carry out all investigations for target organ damage for adults with newly diagnosed hypertension within 1 month of diagnosis.

Adults with newly diagnosed hypertension (high blood pressure) receive tests within 1 month of being diagnosed to check for any damage to organs such as their eyes, heart or kidneys.

Source guidance

Hypertension in adults: diagnosis and management. NICE guideline NG136 (2019, updated 2023), recommendations 1.2.5 and 1.3.3

Definitions of terms used in this quality statement

Investigations for target organ damage

For all adults with hypertension, healthcare professionals should offer to:

  • test for the presence of protein in the urine by sending a urine sample for estimation of the albumin:creatinine ratio and test for haematuria using a reagent strip

  • take a blood sample to measure glycated haemoglobin, electrolytes, creatinine, estimated glomerular filtration rate, serum total cholesterol and high-density lipoprotein cholesterol

  • examine the fundi for the presence of hypertensive retinopathy

  • arrange for a 12‑lead electrocardiograph to be performed.

[NICE's guideline on hypertension in adults, recommendation 1.3.3]

Target organ damage

Damage to organs such as the heart, brain, kidneys and eyes. Examples are left ventricular hypertrophy, chronic kidney disease, hypertensive retinopathy or increased urine albumin:creatinine ratio. [NICE's guideline on hypertension in adults, terms used in this guideline]