Hypertension case-finding

In England most community pharmacies signed up to offer the hypertension case-finding service. Initially it had to be provided by a pharmacist but, from December 2023, the scope was expanded to allow delivery by suitably trained and competent pharmacy technicians in order to utilise the skills of the wider team.

The responsible pharmacist must ensure that delegated tasks are undertaken safely by competent pharmacy staff. Pharmacy owners must ensure that all those providing the service are appropriately trained and clinical supervision by the pharmacist is in place.

Under the terms of the service specification, opportunistic blood pressure checks may be offered to identify people with high blood pressure and should be targeted at those aged 40 years or older at risk of hypertension, who have previously not had a confirmed diagnosis (or, at the discretion of the pharmacy team, people under the age of 40 years). The next step depends on the clinical readings (see Table 1):

• Normal blood pressure (90/60mmHg – 139/89mmHg): promote healthy lifestyle behaviours
• High blood pressure (140/90mmHg – 179-119mmHg): offer ambulatory blood pressure monitoring (ABPM) from the pharmacy and promote healthy behaviours
• Very high blood pressure (greater than 180/120mmHg): refer for same day appointment with GP (or other locally agreed urgent care). Refer to A&E if acute symptoms
• Low blood pressure (less than 90/60mmHg): provide appropriate advice.

Additionally, patients may be referred for a blood pressure check by their GP practice – for example, where they are already diagnosed with hypertension but the practice has no recent blood pressure readings recorded or where there is a requirement for ambulatory blood pressure monitoring. All results should be reported to the patient’s GP to be recorded in their medical record.

The GP practice concerned is responsible for further evaluation of people referred for same day or urgent examination as well as those diagnosed with high blood pressure. Patient referrals should be in line with national guidelines for diagnosing and treating hypertension (see Table 1 for the relevant NICE guidance).

People visiting a pharmacy may not be aware of the service so pharmacy teams should think about how they can promote it. Examples include:

• Having a blood pressure stand in the pharmacy and ensuring patient information leaflets from reputable sources are clearly on display
• Having stickers or leaflets to go into prescription bags
• Linking with other pharmacy health promotion activities where people are already engaged
• Considering how to identify people through the pharmacy’s flu/Covid vaccination service
• Promoting the service on the pharmacy’s website or social media platforms.

Scotland, Wales and Northern Ireland have previously run pilot projects looking at blood pressure monitoring in community pharmacy but currently there are no nationally commissioned services in these countries. It may be a service that pharmacies could choose to offer or a locally commissioned service could be agreed at health board/district level.

Pharmacy teams can also advise people on purchasing a monitor and support them in using it correctly at home (see bloodpressureuk.org/your-blood-pressure/how-to-lower-your-blood-pressure/monitoring-your-blood-pressure-at-home/how-to-measure-your-blood-pressure-at-home).