When should I consider referring a patient for specialist assessment b

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Consider referring a patient for specialist assessment based on blood pressure monitoring results in the following situations:

If the patient has a clinic blood pressure of 180/120 mmHg or higher with signs of retinal haemorrhage or papilloedema (accelerated hypertension), or life-threatening symptoms such as new onset confusion, chest pain, signs of heart failure, or acute kidney injury, refer for same-day specialist assessment .
If the patient has a clinic blood pressure of 180/120 mmHg or higher but no immediate signs requiring same-day referral, carry out investigations for target organ damage promptly; if damage is identified, consider starting treatment immediately and refer for specialist assessment as needed .
If blood pressure measurements do not confirm postural hypotension despite suggestive symptoms, consider referral for further specialist assessment .
If symptoms of postural hypotension persist despite addressing likely causes (including medication review), consider referral to specialist care .
In cases of resistant hypertension where blood pressure remains uncontrolled despite optimal tolerated doses of four drugs, seek specialist advice .
If suspected phaeochromocytoma is present (e.g., labile or postural hypotension, headache, palpitations, pallor, abdominal pain, or diaphoresis), refer for same-day specialist assessment .

When should I consider referring a patient for specialist assessment based on their blood pressure monitoring results?