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NICE Hypertension Calculator

Adults ≥18 · NICE NG136 Hypertension in adults: diagnosis and management (last updated 26 Feb 2026)

Scenario

Patient

Comorbidities & risk

QRISK3 10-year risk calculator

Optional. Calculates the 10-year risk of heart attack or stroke and fills in the QRISK3 box above. Uses the age, sex, clinic systolic BP, diabetes and CKD entered in this form. For adults aged 25–84 without established CVD.

Enter QRISK3 details

SBP variability = standard deviation of at least two recent systolic readings; leave blank if unknown (an average value is assumed). Townsend deprivation score from the postcode; leave blank for 0 (about average).

Blood pressure

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For postural checks, enter the lying (or seated) reading as the clinic BP and the standing reading here.

Red flags

Current antihypertensives

Before stepping up

Known intolerances

NICE-recommended plan

Enter age and clinic blood pressure to see the plan.

Decision support only, based on NICE NG136 and the cross-referenced targets from NG203 (CKD) and NG17 (type 1 diabetes). It does not replace clinical judgement, the full guideline or local formularies. Excludes pregnancy (NG133), under-18s and secondary hypertension management.

Quick reference

Diagnosis & staging
StageClinicABPM / HBPM
Stage 1140/90 – 159/99135/85 – 149/94
Stage 2≥160/100 and <180/120≥150/95
SevereSys ≥180 or dia ≥120–

Diagnosis = clinic ≥140/90 and ABPM daytime / HBPM average ≥135/85 (1.2.8). ABPM: ≥2 readings/hour while awake, average of ≥14. HBPM: 2 readings ≥1 min apart, twice daily, 4–7 days, discard day 1.

Clinic BP targets
Group<80 yrs≥80 yrs
Hypertension ± T2DM<140/90<150/90
T1DM, ACR <70<140/90<150/90
T1DM, ACR ≥70<130/80<150/90
CKD, ACR <70<140/90<140/90
CKD, ACR ≥70<130/80<130/80

ABPM/HBPM targets: <135/85 (under 80), <145/85 (80 and over). Same targets with or without CVD (1.4.23). Use standing BP if significant postural drop.

Drug treatment steps
StepTreatment
1T2DM (any age/origin) or <55 and not Black African/African–Caribbean → ACEi or ARB
≥55, or Black African/African–Caribbean (no T2DM) → CCB
CCB not tolerated or heart failure → thiazide-like diuretic
2On A → add C or D. On C → add A or D (ARB preferred over ACEi if Black African/African–Caribbean)
3A + C + D (check adherence and optimal doses first)
4Resistant hypertension – confirm with ABPM/HBPM, check postural BP and adherence. K⁺ ≤4.5 → consider low-dose spironolactone; K⁺ >4.5 → consider alpha- or beta-blocker; or seek specialist advice
–Uncontrolled on optimal doses of 4 drugs → seek specialist advice. Consider earlier referral if under 40 or suspected secondary cause (e.g. low K⁺)

A = ACEi or ARB (never both), C = CCB, D = thiazide-like diuretic.

Antihypertensive drugs – 20 commonly used (doses, side effects, contraindications)

Quick check when agreeing a plan or prescribing. Typical adult doses only; always confirm against the BNF, the SmPC and local formulary (prescribe modified-release preparations by brand).

Same-day referral
  • Clinic BP ≥180/120 with retinal haemorrhage/papilloedema (accelerated hypertension) or life-threatening symptoms (new confusion, chest pain, signs of heart failure, AKI) (1.5.2)
  • Suspected phaeochromocytoma (1.5.3)
Lifestyle advice & patient leaflet

Offer to everyone with suspected or diagnosed hypertension and repeat periodically (1.4.1), and to anyone with raised BP who is not diagnosed (1.2.11).

  • Diet and regular exercise – give guidance plus written or audiovisual material (1.4.2)
  • Alcohol – ask, and encourage reduction if excessive (1.4.3)
  • Discourage excessive coffee and caffeine-rich products (1.4.4)
  • Low sodium; no potassium-chloride salt substitutes in older people, diabetes, pregnancy, kidney disease or those on ACEi/ARB (1.4.5)
  • Do not offer calcium, magnesium or potassium supplements to lower BP (1.4.6)
  • Smoking cessation advice and support (1.4.7)
  • Signpost local group-based lifestyle support (1.4.8)