Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Contents Overview 5 Who is it for? 5 1.1 Measuring blood pressure 6 1.3 Assessing cardiovascular risk and target organ damage 10 1.4 Treating and monitoring hypertension 11 1.5 Identifying who to refer for same-day specialist review 23 Terms used in this guideline 24 Recommendations for research 26 1 Automated blood pressure monitoring in people with atrial fibrillation 26 2 Thresholds for interventions in adults aged under 40 26 3 Blood pressure targets for people aged over 80 27 5 Relaxation therapies 27 6 Same-day hospital specialist assessment 28 7 Blood pressure targets for people with aortic aneurysm 28 8 Blood pressure targets for people with prior ischaemic or haemorrhagic stroke 28 Rationale and impact 30 Diagnosing hypertension 30 Relaxation therapies 32 Starting antihypertensive drug treatment 33 Monitoring treatment and blood pressure targets 35 Choosing antihypertensive drug treatment for people with cardiovascular disease 40 Step 4 treatment 43 Identifying who to refer for same-day specialist review 45 Finding more information and committee details 49 Update information 50 This guideline replaces CG127. This guideline partially replaces NG28. This guideline is the basis of QS181, QS28 and QS209. Overview This guideline covers identifying and treating primary hypertension (high blood pressure) in people aged 18 and over, including people with type 2 diabetes. It aims to reduce the risk of cardiovascular problems such as heart attacks and strokes by helping healthcare professionals to diagnose hypertension accurately and treat it effectively. NICE has also produced a guideline on hypertension in pregnancy. Who is it for? 