Hypertension in Adults: Diagnosis and Management (NICE NG136)

NICE NG136 provides comprehensive guidance on the identification, assessment, and treatment of hypertension in adults. Updated 2023 to include ambulatory blood pressure monitoring thresholds and updated treatment algorithms.

Key Recommendations

• Diagnose hypertension using clinic blood pressure ≥140/90 mmHg confirmed with ambulatory or home readings
• Offer antihypertensive treatment to all adults with stage 1 hypertension if ≥80 years, or with comorbidities including CVD, renal disease, diabetes, or 10-year CVD risk ≥10%
• First-line: ACE inhibitor or ARB (not in combination). CCB as alternative if ACE inhibitor/ARB not tolerated
• If >55 years or Black African/Caribbean origin, first-line CCB
• Target BP <140/90 mmHg for <80 years; <150/90 mmHg for ≥80 years
• Review lifestyle: sodium reduction, exercise, alcohol limitation, weight management
• Use QRISK3 to assess 10-year CVD risk for treatment decisions