Current RMA Instruments
| Reasonable Hypothesis SOP | 21 of 2022 |
| Balance of Probabilities SOP | 22 of 2022 |
Changes from previous Instruments
ICD Coding
- ICD-9-CM Codes: 401, 405
- ICD-10-AM code I10 or I15
Brief description
Hypertension is persistently elevated arterial blood pressure. This is a risk factor for subsequent disease rather than strictly a disease in its own right. However, it is treated as a disease for SOP/DVA purposes.
Confirming the diagnosis
The diagnosis needs to be made by a medical practitioner. The elevation in blood pressure must be persistent – this requires multiple elevated measurements over a period of time without normal measurements in between.
The relevant medical specialist is a physician, although a specialist report will not generally be required.
Additional diagnoses covered by these SOPs
- Essential / idiopathic / primary hypertension
- Malignant hypertension
- Secondary hypertension
Conditions not covered by these SOPs
- Temporary elevations of blood pressure NIF
- Borderline hypertension - BP <140/<90 (or equivalent in non clinic setting) and not on treatment to reduce blood pressure) NIF
- Eclampsia, pre-eclampsia and pregnancy associated hypertension #
- Labile hypertension - BP not permanently elevated and not on treatment to reduce blood pressure NIF
- Pulmonary hypertension#
# non-SOP condition
Clinical onset
The clinical onset will be when the blood pressure first became persistently elevated, or when treatment was first commenced to control blood pressure. A normal blood pressure reading when on no treatment precludes a clinical onset before that reading (in the absence of extenuating circumstances).
Clinical worsening
The natural history of hypertension is that it can generally be adequately controlled by medication and/or lifestyle and dietary changes. Different medications may need to be tried, alone or in combination, to find suitable treatment for an individual. Increases or changes in medication may be required, over time, to maintain control. A major reason for inadequate control is lack of patient complaince with treatment. Poor control of hypertension increases the risk of complications, particularly cardiovascular disease, cerebrovascular disease and renal impairment. The development of complications is not necessarily evidence of worsening of hypertension. There is an increased risk of developing complications even with well controlled hypertension. Establishing whether worsening has occurred can be difficult and medical advice should be sought.
Further comments on diagnosis
- Hypertension may be symptomless for many years. There are few if any physical signs until the advent of complications.
- A clinic reading where the systolic pressure is < 140 and diastolic pressure is < 90 at any time (not on treatment) will generally preclude the diagnosis of hypertension prior to that time.
- A single elevated reading does not establish a diagnosis of hypertension.
- Establishing the time of onset of hypertension may be difficult, seek medical advice if in doubt.