Quality standard
Quality statement 4: Blood pressure targets
Quality statement 4: Blood pressure targets
Quality statement
Adults with hypertension have a blood pressure target set that is appropriate for their age and whether blood pressure is measured in clinic or by ambulatory or home monitoring.
Rationale
Hypertension is associated with a higher risk of cardiovascular events. Setting blood pressure to recommended levels aims to promote primary and secondary prevention of cardiovascular disease, and to lower the risk of cardiovascular events. The target depends on the person's age (aged under 80 or 80 and over) and whether blood pressure is measured in a clinic setting or by ambulatory blood pressure monitoring (ABPM) or home blood pressure monitoring (HBPM).
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.
Outcome
a) The proportion of adults aged under 80 years with hypertension who have a blood pressure below 140/90 mmHg, or below 135/85 mmHg if measured using ABPM or HBPM.
Numerator – the number of adults in the denominator who have a blood pressure below 140/90 mmHg, or below 135/85 mmHg if measured using ABPM or HBPM.
Denominator – the number of adults aged under 80 years with hypertension.
Data source: Quality and Outcomes Framework indicator HYP008 reports the percentage of patients aged 79 years or under with hypertension in whom the last blood pressure reading (measured in the preceding 12 months) is 140/90 mmHg or less (or equivalent home blood pressure reading). CVD Prevent indicator CVDP002HYP reports the percentage of patients aged 18 to 79 years with GP-recorded hypertension in whom the last blood pressure reading within the preceding 12 months is equal to 140/90 mmHg or less.
b) The proportion of adults aged 80 years and over with hypertension who have a blood pressure below 150/90 mmHg, or below 145/85 mmHg if measured using ABPM or HBPM.
Numerator – the number of adults in the denominator who have a blood pressure below 150/90 mmHg, or below 145/85 mmHg if measured using ABPM or HBPM.
Denominator – the number of adults aged 80 years and over with hypertension.
Data source: Quality and Outcomes Framework indicator HYP009 reports the percentage of patients aged 80 years or over with hypertension in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less (or equivalent home blood pressure reading). CVD Prevent indicator CVDP003HYP reports the percentage of patients aged 80 years or over with GP-recorded hypertension in whom the last blood pressure reading within the preceding 12 months is 150/90 mmHg or less.
What the quality statement means for different audiences
Service providers (such as general practices) ensure that systems are in place for adults with hypertension have a blood pressure target set that is appropriate for their age and whether blood pressure is measured in clinic or by ambulatory or home monitoring.
Healthcare professionals (such as GPs and practice nurses) ensure that adults with hypertension have a blood pressure target set that is appropriate for their age and whether blood pressure is measured in clinic or by ambulatory or home monitoring. They should use clinical judgement when agreeing blood pressure targets with adults with frailty or multimorbidity.
Commissioners ensure that they commission services that have arrangements for adults with hypertension to have a blood pressure target set that is appropriate for their age and whether the blood pressure is measured in clinic or by ambulatory or home monitoring.
Adults who have hypertension (high blood pressure) have a target clinic blood pressure) that is appropriate for their age and whether blood pressure is measured in their GP practice or clinic or by ambulatory or home monitoring.
Source guidance
Hypertension in adults: diagnosis and management. NICE guideline NG136 (2019, updated 2023), recommendations 1.4.20 to 1.4.22
Equality and diversity considerations
Targets are based on evidence of safe practice. An adult aged 80 years or over with diagnosed hypertension would not have a target clinic blood pressure of 150/90 mmHg if their blood pressure was already treated to below this threshold. Healthcare professionals should use clinical judgement when agreeing blood pressure targets with adults with frailty or multimorbidity.