Intermediate Care

Please click here for a visual summary of the latest NICE guidance, Aug 2019.

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Please note, same day specialist assessment is reserved for those with a BP over (either systolic or diastolic in excess of) 180/120 mmHg AND 

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Malignant hypertension criteria (2)

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• retinal haemorrhage or papilloedema (accelerated hypertension) or, often with a severre headache and blood and protein in the urine

• life-threatening symptoms such as new onset confusion, chest pain, signs of heart failure, or acute kidney injury or

• suspected pheochromocytoma (for example, labile or postural hypotension, headache, palpitations, pallor, abdominal pain or diaphoresis)*

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​Without these indications to admit, the Renal team have developed the following advice:

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(1) Add-on therapy:​

Aim to get a balance between the angiotensin system blockade, beta blockers and vasodilators (they workj in synchrony.

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(2) Malignant hypertension criteria - see top of page

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(3) Increase in therapy:

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(4) Booking ultrasound:

For Virtual Ward referrals oly: Request the ultrasound as "Urgent Outpatient" under Responsible Clinician Dr Mark Battle

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*More on clinical presentation of pheochromocytoma

Symptoms and signs of pheochromocytoma include the following:

• Headache

• Sweating

• Palpitations

• Tremor

• Nausea

• Weakness

• Pallor

• Anxiety, sense of doom

• Epigastric pain

• Flank pain

• Constipation

• Weight loss

The classic history of a patient with a pheochromocytoma includes spells characterized by headaches, palpitations, and diaphoresis in association with severe hypertension. These 4 characteristics together are strongly suggestive of a pheochromocytoma. In the absence of these 3 symptoms and hypertension, the diagnosis may be excluded. (Blake 2020 Medscape.com)

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