Quality standard

Quality statement 2: Blood pressure control

Quality statement 2: Blood pressure control

Quality statement

Adults with chronic kidney disease (CKD) have their blood pressure maintained within the recommended range. [2011, updated 2017]

Rationale

People with CKD are at a higher risk of high blood pressure. Maintaining blood pressure within a target range reduces the risk of cardiovascular disease, CKD progression and mortality.

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.

Structure

a) Evidence of local systems to identify and invite adults with CKD to have a blood pressure reading.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, through local protocols on appointment reminders.

b) Evidence of the availability of equipment to take a blood pressure reading from adults with CKD.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, local protocols and service specifications.

Process

a) Proportion of adults with CKD with an albumin:creatinine ratio (ACR) below 70 mg/mmol whose systolic blood pressure is between 120 mmHg and 139 mmHg and their clinic diastolic blood pressure below 90 mmHg.

Numerator – the number in the denominator whose systolic blood pressure is between 120 mmHg and 139 mmHg and their clinic diastolic blood pressure below 90 mmHg.

Denominator – the number of adults with CKD with an ACR below 70 mg/mmol.

Data source: CVD Prevent's indicator CVDP007CKD reports the percentage of patients aged 18 and over with GP recorded CKD (G3a to G5) with an ACR of less than 70 mg/mmol, in whom the last blood pressure reading (measured in the preceding 12 months) is less than 140/90 mmHg.

b) Proportion of adults with CKD whose systolic blood pressure is between 120 mmHg and 129 mmHg and their clinic diastolic blood pressure below 80 mmHg.

Numerator – the number in the denominator whose systolic blood pressure is between 120 mmHg and 129 mmHg and their clinic diastolic blood pressure below 80 mmHg.

Denominator – the number of adults with CKD.

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

c) Proportion of adults with CKD and an ACR of 70 mg/mmol or more whose systolic blood pressure is between 120 mmHg and 129 mmHg and their clinic diastolic blood pressure below 80 mmHg.

Numerator – the number in the denominator whose systolic blood pressure is between 120 mmHg and 129 mmHg and their clinic diastolic blood pressure below 80 mmHg.

Denominator – the number of adults with CKD and an ACR of 70 mg/mmol or more.

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

Outcomes

a) Prevalence of cardiovascular disease among people with CKD.

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

b) Incidence of cardiovascular events for people with CKD.

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

c) Cardiovascular mortality rates among people with CKD.

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

d) Incidence of end-stage kidney disease.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from audit of health records. The UK Renal Registry annual report includes data on the incidence of kidney replacement therapy.

What the quality statement means for different audiences

Service providers (such as general practices and secondary care services) ensure that systems are in place for adults with CKD to have their blood pressure maintained within the recommended range. This might involve having the equipment to take a blood pressure reading, using clinical IT systems to compare patients to the recommended range when entering a blood pressure reading, or flagging when patients need a blood pressure reading.

Healthcare professionals (such as GPs, nephrologists, nurses and pharmacists) monitor the blood pressure of adults with CKD and are aware of the recommended ranges. They support people to keep their blood pressure within the recommended range, for example, by starting or adjusting treatment, or advising on lifestyle changes.

Commissioners ensure that they commission services in which adults with CKD have their blood pressure maintained within the recommended range. They work with service providers to ensure that adults with CKD are identified, and have a blood pressure reading and any necessary support to maintain it within the recommended range.

Adults with CKD are supported to keep their blood pressure at a healthy level. If it is too high, their healthcare professional might offer medicine, or change the medicine they are taking, or suggest lifestyle changes, to help to control it.

Source guidance

Chronic kidney disease: assessment and management. NICE guideline NG203 (2021), recommendations 1.6.1 and 1.6.2

Definitions of terms used in this quality statement

Adults with CKD

CKD is defined as abnormalities of kidney function or structure present for more than 3 months, with implications for health. This includes:

  • people with markers of kidney damage, including albuminuria (ACR more than 3 mg/mmol), urine sediment abnormalities, electrolyte and other abnormalities due to tubular disorders, abnormalities detected by histology, structural abnormalities detected by imaging or a history of kidney transplantation

  • people with a glomerular filtration rate (GFR) of less than 60 ml/min/1.73 m2 on at least 2 occasions separated by a period of at least 90 days (with or without markers of kidney damage).

[NICE's guideline on chronic kidney disease, terms used in this guideline]