Adults with hypertension: recommendations for minimum standards rather than optimal monitoring?

Hypertension is highly prevalent, both in the UK and globally, with as many as one in three adults diagnosed.1 It is the world’s commonest long-term condition. Although it is possible for some people to achieve remission of hypertension, such as through weight-loss, exercise programmes, or low salt diets, these people are in the minority. For most, hypertension represents a chronic condition that requires regular medications and therefore potentially long-term monitoring, the majority of which takes place in primary care. Despite this, recommendations about how best to monitor people with hypertension are not clearly informed by high-quality evidence. This is the important research gap addressed in this month’s issue of the BJGP .2 The authors, Martha Elwenspoek et al , sought to rigorously identify relevant data from clinical guidelines, systematic reviews, or primary studies, and combined this with primary data analyses and a consensus study. From 16 candidate blood tests, they recommend that a minimal set of blood tests for monitoring in hypertension would include estimated glomerular filtration rate (eGFR), haemoglobin A1C (HbA1c), potassium, and sodium (although eGFR in most laboratories is based on a creatinine measurement). They found high-quality evidence that people with hypertension are at increased risk of chronic kidney disease (CKD) and diabetes, and that commonly prescribed antihypertensive medications are associated with hyperkalaemia, meaning that monitoring of sodium and potassium was also justified. While urine albumin to creatinine (ACR), usually by a spot urine test, is another important test to screen for CKD in people with hypertension that is poorly implemented globally,3 this was outside …