HT Diagnostic Tool

NICE NG136 · Home BP monitoring · ABPM confirmation · White coat detection · Stage classification
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SynaptAI Limited
CDMtools · cdmtools.co.uk
Patient details
Clinical context
Clinic BP readings
Both arms at first appointment — use higher-reading arm thereafter. Take a second reading if first ≥140/90 mmHg. Use lower of two readings per NICE NG136.
Reading 1
Reading 2
Reading 3
Clinic average: enter readings above
7-day home BP monitoring
ⓘ Seated, arm at heart level, 5 mins rest before each reading. No caffeine, exercise or smoking 30 mins prior. Same arm throughout. Day 1 excluded from average per NICE NG136.
MorningEvening
SBPDBPSBPDBP
■ Clinical confirmation — required before generating
0 / 6 confirmed
Patient eligibility
Professional acknowledgement

Outputs are for guideline reference only (NICE NG136). © 2026 SynaptAI Limited · SAI-CDM-003

⬡

Enter clinic and/or home readings, complete the confirmation checklist,
then press Generate Diagnostic Summary.

Use the Quick Reference tab above for the printable A4 cheat sheet.

📄  Hypertension Quick Reference — NICE NG136

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Clinic BP Classification (NICE NG136)
Clinic BP (mmHg)StageAction
<140/90 Normal Reassess at routine review
140–159 / 90–99 Stage 1 Confirm with HBPM/ABPM before treating
160–179 / 100–109 Stage 2 Offer HBPM/ABPM; consider treating before confirmation if high CV risk
≥180 / ≥110 Stage 3 Same-day assessment; assess end-organ damage
Always use the lower of two clinic readings. Take second reading if first ≥140/90 mmHg.
Confirmation Thresholds — ABPM / HBPM
MethodConfirmed HT threshold
Clinic≥140/90 mmHg
ABPM / HBPM (daytime average)≥135/85 mmHg
Home Stage 2≥150/95 mmHg
Diagnostic categories
White coat HT Clinic ≥140 + Home <135 — do not treat; annual review
Masked HT Clinic <140 + Home ≥135 — treat as confirmed
Sustained HT Both elevated — confirmed hypertension
Normal Both below thresholds — reassess routinely
7-Day HBPM Protocol (NICE NG136)
1
Twice daily — morning and evening — for 7 days
2
Seated, feet flat, arm supported at heart level. Rest 5 mins before each reading
3
No caffeine, exercise, or smoking 30 mins before readings
4
Same arm throughout (use higher-reading arm from first appointment)
5
Discard Day 1 readings — average days 2–7 only
6
Use validated monitor with appropriate cuff size (upper arm preferred)
Day 1 discarded to exclude alerting response. Up to 12 session pairs (24 readings) contribute to the average.
BP Targets by Context
ContextTarget
Standard (no DM, no CKD)≤140/90 mmHg
CKD or diabetes≤130/80 mmHg
CKD + proteinuria (ACR ≥70)≤130/80 mmHg
Age ≥80, fit and independent≤150/90 mmHg
Frailty / significant comorbidityClinical judgement
Home / ABPM equivalent (standard)≤135/85 mmHg
Home / ABPM equivalent (tight)≤130/80 mmHg
For patients aged ≥75, review antihypertensive burden against falls risk and orthostatic hypotension at every review.
Treatment Pathway — A/C/D (NICE NG136)
1
ACEi or ARB
e.g. Ramipril 2.5mg — titrate to max tolerated. Check U&E + K⁺ in 2 weeks. First-line in CKD.
2
Add Calcium channel blocker
e.g. Amlodipine 5mg — can uptitrate to 10mg. Add when ACEi/ARB at max dose.
3
Add Thiazide-like diuretic
e.g. Indapamide 1.5mg MR. Add when steps 1+2 at max. Ensure all agents optimised first.
4
Resistant HT — Spironolactone or alpha/beta-blocker
Spironolactone 25mg if K⁺ <4.5 mmol/L. Seek specialist input if uncontrolled on ≥3+ agents.
Resistant HT = BP above target on ≥3 agents at optimal doses. Confirm adherence before stepping up.
Secondary HT — When to Investigate
Red flags
Age <40 with confirmed or suspected HT
Stage 2+ hypertension, especially new onset
Resistant HT on ≥3 agents at optimal doses
Hypokalaemia (K⁺ <3.5 mmol/L) without diuretic use
Episodic headache, palpitations, sweating (phaeochromocytoma)
Abdominal bruit (renal artery stenosis)
Key investigations
Suspected causeInvestigation
Conn's (primary hyperaldosteronism)Fasting renin:aldosterone ratio
Phaeochromocytoma24hr urinary catecholamines / plasma metanephrines
Renal artery stenosisRenal USS ± duplex Doppler
Renal parenchymal diseaseU&E, ACR, eGFR, renal USS
CoarctationRadiofemoral delay, CXR, Echo
Female of childbearing age: review ACEi/ARB and contraindication profile before prescribing. Refer all secondary HT to specialist.
Guideline reference only — NICE NG136 (Hypertension in adults: diagnosis and management). All values require clinical judgement applied to the individual patient. For patients aged ≥75 or with frailty, targets should be reviewed against individual circumstances. © 2026 SynaptAI Limited · SAI-CDM-003 · cdmtools.co.uk
Values marked with data-gkey are updatable via Cloudflare KV — push ht-guidance.json to GitHub to update.
HT Diagnostic Tool · Quick Reference · SynaptAI Limited · SAI-CDM-003 · NICE NG136 · © 2026 · cdmtools.co.uk · Guideline reference only — all recommendations require clinical judgement.