Hypertension NICE CKS Guidelines | Super Notes for PLAB 1

Confused about the Hypertension NICE CKS guidelines? We have crafted a quick review summary! Below we have made the topic approachable, and simpler to memorize and understand. Have a quick read.

Defining Hypertension NICE CKS

20-40-60 rule! (from 120)

Stage 1

Clinic =140/90 mm Hg or ABPM/HBPM = 135/85 mm Hg

Stage 2

Clinic = 160/100 mm Hg or ABPM/HBPM = 150/95 mm Hg

Stage 3

Clinic = 180/120 mm Hg

where ABPM= Ambulatory Blood Pressure Monitoring and HBPM= Home Blood Pressure Monitoring, SBP= Systolic Blood Pressure, DBP= Diastolic Blood Pressure

Blood Pressure Targets

Many students are confused about BP targets as per Hypertension NICE CKS guidelines. These are as follows:

For CKD (with DM or Urinary ACR>70)

  • <130/80 mm Hg (120-129 systolic and <80 for diastolic)

For HTN without DM or With DM (Same)

  • Age<80 years- Clinic = 140/90 mm Hg or ABPM/HBPM = 135/85 mm Hg
  • Age>80 years- Clinic = 150/90 mm Hg or ABPM/HBPM= 145/85 mm Hg

Special Scenarios

White-Coat/Masked HTN

Record HBPM/ABPM (same 135/85 for <80 YO and 145/85 for >80 YO)

Postural Hypotension

Always record standing BP

Important Notes

Some important notes to know for the exam before diving into Hypertension NICE CKS guidelines:

  • Lifestyle Modifications>Any Anti-hypertensive
  • Low salt diet (Salt intake recommendation for adults in the UK is no more than 6 gm per day which is around 1 teaspoon)
  • Always prefer ARB over ACEi in Africa-Caribbean
  • Before commencing ACEi- Check eGFR
  • If eGFR is low <30 as in advanced CKD- ACEi and ARBs should be avoided in this case

Why ACE inhibitors in Diabetic Hypertensives?

  • Reno-protective
  • Protection against diabetic retinopathy
  • Positive effect on glucose metabolism

Hypertension Treatment Protocol

Clinic BP >180/120 mm Hg (Severe HTN)


  • Life-threatening signs (Confusion, Chest pain, Signs of HF, AKI)
    • Above features present- Refer to A&E


  • Fundoscopy- Retinal Haemorrhage, Papilloedema (Accelerated/Malignant HTN)
    • Present- Refer to A&E
    • Absent- Look for Target Organ Damage
      • Present- Start Anti-HTN
      • Absent- Repeat BP in 7 days (without ABPM)
  • Assessing Organ Damage
    • Fundoscopy- Retinal Haemorrhage, Papilloedema
    • Urine ACR
    • HbA1C
    • KFT- CKD
    • ECG- LVH

Clinic BP 140/90 to 179/119

  • Offer ABPM before Anti-HTN
    • ABPM>135/85 mm Hg to 149/94 mm Hg (Stage 1)- Lifestyle changes
    • ABPM>150/95 mm Hg (Stage 2)- Start Anti-HTN

Steps of Management of Hypertension

Steps of management as per NICE guidelines:

Step 1

  • DM- ACEi or ARB (Africo-Caribbean) (race and age is irrelevant)
  • Age <55 years- ACEi or ARBs
  • Age >_55 years/ Afro-Caribbean- CCB
  • ACEi not tolerated (ACE- A- Angioedema, C- Cough, E- Elevated Potassium)- ARB
  • CCB not tolerated (Ankle oedema/Gingival hyperplasia)> Thiazide-like diuretic
  • Evidence of HF- Thiazide like diuretic
  • Thiazide-like diuretic- Indapamide>Bendroflumethiazide (do not change if already on Bendro/HCTZ)

Step 2 (still hypertensive after step 1)

  • CCB/Thiazide- If not controlled on ACEi/ARB
  • ARB- Africo-Caribbean without DM and not controlled on CCB

Step 3

  • Add remaining of 3 (CCB, ACEi/ARB, Thiazide-like)

Step 4- Resistant Hypertension

  • Check for Postural Hypotension (?Pheochromocytoma/Addison’s)
  • Add 4th Anti-HTN
  • Potassium levels
    • K+<4.5- Spironolactone (25mg od)
    • K+>4.5- Alpha/Beta Blocker

Step 5

  • Patients who fail to respond to step 4 measures Should be referred to a Specialist
  • NICE recommend- If BP remains uncontrolled with the optimal or maximum tolerated doses of four drugs- Seek Expert Advice

Loved these short notes? Check out our other guides for PLAB 1:

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Please note, that the above-mentioned information on Hypertension NICE CKS guidelines is meant to be used for educational purposes alone. MedicForYou does not hold responsibility for the usage of the information in any clinical or practical life.

This guide is exclusively made for students preparing for PLAB 1 exam. Any updates shall be made readily whenever there are official changes in the guidelines.

If there is any missing or incorrect information, we invite you to help us correct it by mailing us or mentioning it in the comments below.

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