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Hypertension

Emergency department referrals

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • Suspected acute target organ damage regardless of BP (e.g. acute coronary syndrome, acute heart failure, aortic dissection or aneurysm, acute kidney injury, major neurological changes, hypertensive encephalopathy, papilloedema, acute stroke - haemorrhagic or ischaemic/thromboembolic)
  • Severe hypertension in pregnancy (systolic blood pressure equal to or greater than 140 mmHg and/or diastolic blood pressure equal to or greater than 90 mmHg), including suspected pre-eclampsia refer patient to the emergency department or maternity assessment unit of a facility that offers obstetric services where possible.
  • Phaeochromocytoma crisis with sudden severe hypertension

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

All hypertension referrals should be directed to General Medicine, unless the referral contains specific clinical indicators warranting sub-specialist review. Referrals may be allocated to Kidney Medicine, Cardiology, or Endocrinology where clearly justified by comorbidities, diagnostic complexity, or suspected secondary causes of hypertension.

  • Severe or poorly controlled hypertension (typically BP >180/110 mmHg) without acute target organ damage and risk factors (e.g. young onset, sudden onset, rapid progression, medication intolerance, medication non-adherence)
  • Subspeciality referral for the following:
    • Cardiology:
      • Hypertension with symptoms suggestive of angina
      • Hypertension with symptoms suggestive of heart failure
    • Kidney Medicine:
      • If associated significant albuminuria or proteinuria and/or abnormal kidney function
    • Endocrinology:
      • Confirmed or suspected phaeochromocytoma
      • Confirmed or suspected Cushing’s Syndrome
      • Confirmed or suspected Primary Hyperaldosteronism with potassium <3mmol/L

Category 2

Appointment within 90 days is desirable

  • Resistant hypertension – BP>140/90mmHg despite three or more antihypertensives (including a diuretic) at optimal tolerated doses.
  • Subspeciality referral for the following:
    • Cardiology:
      • Uncontrolled hypertension in the context of a history of symptomatic ischaemic heart disease or previous coronary revascularisation
      • Uncontrolled hypertension in the context of known cardiomyopathy (or heart failure)
    • Kidney Medicine:
      • Suspected or confirmed renal artery stenosis
      • Hypertension if associated with CKD Stage 4 or 5
    • Endocrinology:
      • Primary hyperaldosteronism (Conn’s syndrome) with potassium ≥3 mmol/L
      • Patients suspected of having any other secondary endocrine cause for hypertension

Category 3

Appointment within 365 days is desirable

  • Patients with hypertension not reaching target BP levels despite 2 antihypertensive agents
  • Subspeciality referral for the following:
    • Cardiology:
      • Changing pattern of hypertension
    • Kidney Medicine:
      • If associated CKD
      • Hypertension in patients <30 years where a renal cause is suspected (e.g., abnormal urinalysis, proteinuria, haematuria, or reduced eGFR), and blood pressure is controlled on current therapy
    • Endocrinology:
      • Nil

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

  • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

Not an exhaustive list

Referral requirements

A referral may be rejected without the following information.

Essential referral information

  • Medical History & Clinical Background:
    • Detailed medical history emphasising any cardiac, renal, or endocrine concerns.
    • History of blood pressure (BP) measurements (preferred both arms), including 24-hour or home measurements if available.
    • Current medication list, including over-the-counter (OTC) medications, and detailing all treatments tried, including efficacy.
  • Cardiac Investigations:
    • Electrocardiogram (ECG).
    • Echocardiogram*
    • Fasting lipid profile.
  • Renal Investigations:
    • Renin and aldosterone levels.
    • Estimated Glomerular Filtration Rate (eGFR).
    • Urinalysis results.
    • Urine midstream M/C/S (microscopy/culture/sensitivity) for infection, morphology, and casts.
    • urine albumin:creatinine ratio
    • Renal artery assessment via renal duplex report (if stenosis is suspected).
  • Endocrine Investigations:
    • 1mg dexamethasone suppression test and/or 24-hour urinary free cortisol levels.
    • Plasma free metanephrine and normetanephrine levels.
  • Imaging & Other Diagnostic Tests:
    • Chest X-ray report.
  • Laboratory Investigations:
    • Full Blood Count (FBC).
    • Electrolytes, Liver Function Tests (LFTs).

Note: *Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Additional referral information

  • History of smoking, alcohol intake and drug use (including recreational drugs)
  • Ethnicity, highlighting Aboriginal and Torres Strait Islander populations as especially at risk
  • Records and results of investigations pertinent to co-morbidities or tests excluding other secondary causes (e.g., sleep studies).

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can’t order, or the patient can’t afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
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