HT Navigator — CDMtools

Session

Practice

Clinician identity is captured automatically from your login — no initials needed.

Session Ref (Pseudo-ID)

Note this Ref on your consultation record to track the same patient across sessions. No patient names or identifiers.

Patient details

Age (years)

Sex

Ethnicity (affects Step 1 drug choice)

Clinical context

Known CKD

Diabetes

Currently on antihypertensives?

Potassium (mmol/L — optional, secondary HT screening)

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.

	Morning		Evening
	SBP	DBP	SBP	DBP

HBPM diagnostic threshold: ≥135/85 mmHg (average days 2–7) confirms hypertension per NICE NG136.
This differs from the clinic threshold (≥140/90 mmHg) used for stage classification.

■ Clinical confirmation — required before generating

Not confirmed

Patient eligibility

1Patient is 18 years of age or older.

2Patient is not currently pregnant. Pregnancy-related hypertension requires obstetric pathways.

3This is not an acute hypertensive emergency. BP ≥180/120 with end-organ damage symptoms requires emergency management, not this tool.

Professional acknowledgement

4I am a registered healthcare professional. This tool supports but does not replace clinical decision-making.

5Outputs are NICE NG136 guideline references only. I remain solely responsible for all clinical decisions made.

6Home readings were taken under standardised conditions (5 mins rest, correct cuff, consistent timing) — or I have noted any deviations from protocol.

I have read and confirm all six statements above

Outputs are for guideline reference only (NICE NG136). © Gupta R, Gupta A (2026) · CDMtools · cdmtools.co.uk

⬡

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

Clinical Decision Support — Not a substitute for clinical judgement. For use by registered healthcare professionals in NHS primary care. Always apply clinical context. © Gupta R, Gupta A (2026) · CDMtools · cdmtools.co.uk

Patient Parameters High-risk patient (CKD / DM / CVD) — target 130/80

Session

Session Ref (Pseudo-ID)

Clinician identity is captured automatically from your login — no initials needed. No patient names or identifiers.

Patient Details

Age (years)

Sex

Ethnicity

Blood Pressure

Clinic SBP (mmHg)

Clinic DBP (mmHg)

Home SBP avg (mmHg)

Home DBP avg (mmHg)

Renal

eGFR (ml/min/1.73m²)

Previous eGFR

ACR / UACR (mg/mmol)

Lipids & Cardiovascular Risk

Total Cholesterol (mmol/L)

LDL Cholesterol (mmol/L)

Triglycerides (mmol/L)

HDL Cholesterol (mmol/L)

QRISK3 Score (%)

Statin Prescribed

Liver

ALT (U/L)

GGT (U/L)

End-Organ Assessment

ECG LVH

Hypertensive Retinopathy

Medication — tick all currently prescribed

ACEi / ARB

e.g. Ramipril, Lisinopril, Losartan

A — Step 1/2

CCB

e.g. Amlodipine, Felodipine

C — Step 1/2 · First-line Black ethnicity

Thiazide-like diuretic

e.g. Indapamide, Chlortalidone

D — Step 3

MRA (Spiro / Eplerenone)

e.g. Spironolactone 25mg, Eplerenone

Step 4 — resistant HT · Monitor K⁺

Beta-blocker

e.g. Bisoprolol, Atenolol, Carvedilol

Specific indication — AF / angina / HFrEF / post-MI

Alpha-blocker

e.g. Doxazosin

Step 4 — resistant HT · Postural hypotension risk

SGLT2 inhibitor

e.g. Dapagliflozin, Empagliflozin

Indication-specific — CKD / HFrEF / T2DM · Modest BP reduction ~3 mmHg SBP

Medication — Adherence & Review

Adherence Concern

New Med in Last 6wk

Lifestyle

BMI (kg/m²)

Smoking Status

Alcohol (units/week)

Salt Reduction Discussed

Active Days/Week

❤ Cardiovascular Risk — QRISK3

QRISK3 is a registered trademark of ClinRisk Ltd. The validated algorithm is available free at qrisk.org and is embedded in EMIS Health and Vision. Use the official calculator, then enter your result into the Scorecard tab above.

Official QRISK3 Calculator

The validated 10-year CVD risk tool by Hippisley-Cox et al.
Free to use for individual patient assessment at qrisk.org

Open QRISK3 ↗

What you need from the notes

▸ Age & sex

▸ Ethnicity

▸ Deprivation score (Townsend — from postcode)

▸ Systolic BP (and variability if available)

▸ Total cholesterol : HDL ratio

▸ BMI

▸ Smoking status

▸ Family history of CVD (1st degree, <60)

Medical history to include

▸ Type 1 or Type 2 diabetes

▸ Atrial fibrillation

▸ CKD (stage 3, 4 or 5)

▸ Rheumatoid arthritis

▸ Systemic lupus erythematosus (SLE)

▸ Severe mental illness / atypical antipsychotic

▸ Current antihypertensive treatment

▸ On corticosteroids

Interpreting the score — NICE NG238

QRISK3 Score	Risk Level	NICE NG238 Action
<10%	Low	Lifestyle advice. Reassess if risk factors change. Annual BP review.
10–19%	Moderate	Offer atorvastatin 20mg. Document discussion and patient decision. Annual review.
20–29%	High	Offer atorvastatin 20mg (consider 40mg). Address all modifiable risk factors.
≥30%	Very High	Maximise statin (atorvastatin 40–80mg). Secondary prevention pathway. Consider aspirin discussion.

In your clinical system

qrisk.org ↗

EMIS Health — Clinical module → CVD risk

Vision — Opportunistic Screening → QRISK3

After calculating — enter result into the Scorecard

Once you have the QRISK3 score from your clinical system or qrisk.org, go to the Scorecard tab and enter it in the Cardiovascular Risk section. The scorecard will then apply NICE NG238 statin thresholds automatically.

QRISK3 is a registered trademark of ClinRisk Ltd. © Hippisley-Cox J et al. BMJ 2017. CDMtools links to the official validated calculator and does not replicate or embed the algorithm. © Gupta R, Gupta A (2026) · CDMtools · cdmtools.co.uk

📄 Hypertension Quick Reference — NICE NG136

Clinic BP Classification (NICE NG136)

Clinic BP (mmHg)	Stage	Action
<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

Method	Confirmed HT threshold
Clinic	≥140/90 mmHg
ABPM / HBPM (daytime avg)	≥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 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 contribute to the average.

BP Targets by Context

Context	Target
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 comorbidity	Clinical judgement
Home / ABPM (standard)	≤135/85 mmHg
Home / ABPM (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.

4

Resistant HT — Spironolactone or alpha/beta-blocker
Spironolactone 25mg if K⁺ <4.5. 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 cause	Investigation
Conn's (primary hyperaldosteronism)	Fasting renin:aldosterone ratio
Phaeochromocytoma	24hr urinary catecholamines / plasma metanephrines
Renal artery stenosis	Renal USS ± duplex Doppler
Renal parenchymal disease	U&E, ACR, eGFR, renal USS
Coarctation	Radiofemoral delay, CXR, Echo

Female of childbearing age: review ACEi/ARB contraindication before prescribing.

Session

Session Ref (Pseudo-ID)

Note this Ref on your consultation record to track the same patient across sessions. No patient names or identifiers.

Lipid results

Simon Broome Register criteria, per NICE CG71. Adult threshold TC ≥7.5 or LDL-C ≥4.9 mmol/L; child threshold TC ≥6.7 or LDL-C ≥4.0 mmol/L.

Age group

On lipid-lowering therapy?

Total cholesterol (mmol/L)

LDL-C (mmol/L)

Clinical & family history

Tendon xanthomata

In the patient, or in a first- or second-degree relative.

Known pathogenic variant

DNA-confirmed LDLR, APOB or PCSK9 mutation in patient or relative.

Family history of premature MI

MI <60y in a first-degree relative, or <50y in a second-degree relative.

Family history of very raised cholesterol

Total cholesterol >7.5 mmol/L in a first- or second-degree adult relative (>6.7 mmol/L if relative is a child).

Specialised bloods & imaging

Beyond the NHS core lipid panel — for engaged, informed patients pursuing proactive cardiometabolic risk assessment (typically self-funded). Tick items to include in this patient's plan and pull into the summary/link tab.

Lifestyle advice to include

Bespoke note for this patient

Anything specific to what you've discussed today — this is shown to the patient verbatim. Not stored server-side — only sent within the patient link/letter itself.

Selected for this patient

Generate patient letter & link

🔒 Verify patient identity — hashed in browser only, never sent to CDMtools

Date of birth

Postcode

Mail: To: field left blank — confirm recipient in your mail client · Engage: paste into Engage and select patient. Link expires in 14 days.