9.6. Hypertension

Updated 2 October 2025

Standard Operating Procedure for Hypertension Surveillance

 

Effective Date: [Date]

Version: 1.0

Prepared by: [Name/Department]

Approved by: [Name/Department]

 

Status 

Definition 

A

Tested / reflects current policy and updates

B

Possible gaps / may not reflect latest policies and updates / users need to apply due diligence

C

Outline / being updated / users should cross reference other materials (job aids, training resources)

D

Draft / consider as being under development 

E

Work in progress / template created 

 

1. Introduction

This SOP outlines the procedures for the surveillance of Hypertension (HTN) in St. Lucia. It is intended for use by healthcare practitioners, including doctors, nurses, and allied health professionals.

2. Objective

  • To provide a systematic approach for the surveillance of Hypertension.
  • To ensure timely and accurate diagnosis 

3. Scope

This SOP applies to all healthcare facilities and practitioners involved in the care and management of Hypertension in St. Lucia.

4. Definitions

  • Hypertension (HTN): A condition in which the blood pressure in the arteries is persistently elevated. It is defined as a systolic blood pressure (SBP) of ≥140 mmHg and/or a diastolic blood pressure (DBP) of ≥90 mmHg.

5. Roles and Responsibilities

  • Healthcare Practitioners: Diagnose and provide education and counselling to patients; report cases to public health authorities.
  • Public Health Officials: Monitor the prevalence of HTN; implement public health measures; conduct awareness campaigns.
  • Laboratories: Conduct diagnostic tests and report results promptly.

6. Standard Operating Procedure 

Step 1 - Clinical Assessment (Healthcare practitioner)
  • Patient History:
    • Obtain and record detailed medical history, including family history of HTN and cardiovascular disease. Obtain data including – name, date of birth, weight. 
    • Ask about symptoms such as headaches, dizziness, vision changes, chest pain, and shortness of breath.
    • Assess lifestyle factors, including diet, physical activity, smoking, and alcohol consumption.
    • Inquire about stress levels and psychosocial factors.
  • Physical Examination: Measuring blood pressure

Note: healthcare professionals taking blood pressure measurements must have adequate initial training 

  • Measure blood pressure using a validated device.
  • Ensure that the patient arm is outstretched. 
  • Ensure the patient is relaxed and seated with their back supported and feet flat on the floor. (Note: for persons with symptoms of postural hypotension, including falls or postural dizziness, measure blood pressure with the person lying on their back or consider a seated position, if it is inconvenient to measure blood pressure with the person lying down.)
  • Place the cuff on the upper arm at heart level and ensure the correct cuff size.
  • Take at least two readings, one to two minutes apart, and average the results.
  • If blood pressure measured in the clinic is 140/90 mmHg or higher:Take a second measurement during the consultation.
  • If the second measurement is substantially different from the first, take a third measurement.
  • Record the lower of the last 2 measurements as the clinic blood pressure.
  • Physical Examination: Assessment
    • Assess for signs of target organ damage, such as retinal changes, left ventricular hypertrophy, and renal dysfunction.
    • Perform a thorough cardiovascular examination, including heart sounds, pulses, and peripheral edema.

 

Step 2: Reporting (Healthcare practitioner / Laboratory)

  • Add diagnosis to patient form, for patients with a BP reading higher than 140/90 mmHg (report data weekly to primary healthcare director / Epidemiology Unit)
  • Follow up with laboratory tests as needed. 
  • Fill in the results of the laboratory tests once received 

Laboratory Tests may include:

  • Basic tests such as complete blood count (CBC), fasting blood glucose, lipid profile, and urinalysis.
  • Assess renal function with serum creatinine and estimated glomerular filtration rate (eGFR).
  • Measure electrolytes, including sodium and potassium levels.
  • Perform ECG to evaluate cardiac function and detect arrhythmias.
  • Additional tests, such as echocardiography or renal ultrasound, if indicated.

Note: Treat patient according to national standards on patient care and follow up

 

Step 3: Data Management (Epidemiology Unit)

  • Data should be cleaned and analysed 
  • Preparation of a report should be done on the evolution of the epidemiological situation of the disease
  • Dissemination of a weekly situation report