Evidence-based blood tests for monitoring adults with hypertension in primary care: rapid review, routine data analyses, and consensus study.

Abstract (English)

BACKGROUND: Substantial variation in testing rates in adults with hypertension across UK primary care suggest that patients are not receiving optimal monitoring. AIM: To develop a minimal set of evidence-based blood tests for adults with hypertension. DESIGN AND SETTING: This was a rapid review, routine data analyses, and consensus study. It was set in primary care. METHOD: This study examined the rationale and evidence for tests recommended by guidelines or used commonly in adults with hypertension using stepwise rapid evidence reviews. A consensus group, including clinicians and patients, voted to include or exclude each test in the testing panel based on the evidence. If there was no consensus (>80%), additional evidence was sought through rapid reviews or analyses of primary care records, which was subject to further voting. RESULTS: Sixteen routinely ordered tests were identified. The study found consistent, good evidence that estimated glomerular filtration rate (eGFR) to detect chronic kidney disease and glycosylated haemoglobin (HbA1c) to detect diabetes is beneficial for patients. The study found no or inconsistent evidence of the benefit of routinely measuring lipids, electrolytes, haemoglobin, thyroid function, clotting biomarkers, calcium, ferritin, folate acid, or vitamin B12. Good evidence was found that there is no benefit in routinely monitoring liver function, inflammation markers, or brain natriuretic peptide. CONCLUSION: A minimal set of evidence-based blood tests to monitor adults with hypertension was identified. This panel includes eGFR, HbA1c, potassium, and sodium. Implementing these recommendations could reduce harms associated with unwarranted variation in care. Further research is needed to clarify the role of tests with inconsistent evidence and determine the optimal frequency of testing.