Evidence-based blood tests for monitoring adults with hypertension in primary care: rapid review, routine data analyses, and consensus study

Martha M C Elwenspoek; Rachel O'Donnell; Catalina Lopez Manzano; Sarah Dawson; Lewis F Buss; Katie Charlwood; Christina Stokes; Francesco Palma; Alastair D Hay; Penny F Whiting; Jessica Watson

doi:10.3399/BJGP.2025.0209

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Moving towards personalised monitoring intervals for long-term conditions in primary care
Muhammad Mukarrum Saleh and Mehak Fatima

Published on: 12 August 2026

Published on: (12 August 2026)
Page navigation anchor for Moving towards personalised monitoring intervals for long-term conditions in primary care
Moving towards personalised monitoring intervals for long-term conditions in primary care
Muhammad Mukarrum Saleh, General Physician, Sharifa Bibi Memorial Hospital
Other Contributors:
Mehak Fatima, General Physician
We read with great interest Elwenspoek et al.’s evidence-based review of blood tests for monitoring adults with hypertension in primary care. The authors identify a minimal set of tests and appropriately highlight substantial variation in testing and the limited evidence underpinning some recommendations. Importantly, they also note that further research is needed to determine the optimal frequency of testing.¹

We suggest that the next step should be to move beyond defining which tests should be performed towards determining who needs them, and when. Fixed monitoring intervals may be simple to implement, but they risk treating patients with very different levels of disease burden, treatment intensity and complication risk in the same way.

This issue is not unique to hypertension. Previous work has demonstrated that many recommendations for monitoring long-term conditions are not strongly evidence based,² while substantial variation in laboratory testing persists in primary care.³ Such variation may reflect uncertainty about both the necessity and timing of testing.

A risk-stratified approach could potentially address this. Monitoring intervals could be informed by factors such as disease control, comorbidity, medication changes, renal function, previous abnormal results and established complications. Patients at higher risk or with unstable disease could receive more frequent monitoring, whereas stable, low-risk patients m...
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We read with great interest Elwenspoek et al.’s evidence-based review of blood tests for monitoring adults with hypertension in primary care. The authors identify a minimal set of tests and appropriately highlight substantial variation in testing and the limited evidence underpinning some recommendations. Importantly, they also note that further research is needed to determine the optimal frequency of testing.¹

We suggest that the next step should be to move beyond defining which tests should be performed towards determining who needs them, and when. Fixed monitoring intervals may be simple to implement, but they risk treating patients with very different levels of disease burden, treatment intensity and complication risk in the same way.

This issue is not unique to hypertension. Previous work has demonstrated that many recommendations for monitoring long-term conditions are not strongly evidence based,² while substantial variation in laboratory testing persists in primary care.³ Such variation may reflect uncertainty about both the necessity and timing of testing.

A risk-stratified approach could potentially address this. Monitoring intervals could be informed by factors such as disease control, comorbidity, medication changes, renal function, previous abnormal results and established complications. Patients at higher risk or with unstable disease could receive more frequent monitoring, whereas stable, low-risk patients might require less frequent testing. This could reduce unnecessary testing while helping prevent under-monitoring.

The distinction between a minimal evidence-based monitoring schedule and an optimal personalised schedule is therefore important. The former establishes a safety floor; the latter should adapt to individual risk and clinical circumstances.

Future research should focus on validating risk-stratified monitoring intervals across long-term conditions and evaluating their effects on clinical outcomes, patient burden, resource use and health inequalities. Such evidence could support monitoring schedules that are not only evidence based, but also proportionate to individual patient risk.

References

1. Elwenspoek MMC, O’Donnell R, Lopez Manzano C, et al. Evidence-based blood tests for monitoring adults with hypertension in primary care: rapid review, routine data analyses, and consensus study. Br J Gen Pract. 2026;76(769):e663.

2. Elwenspoek MMC, Patel R, Watson JC, et al. Are guidelines for monitoring chronic disease in primary care evidence based? BMJ. 2019;365:l2319.

3. Elwenspoek MMC, et al. Variation in laboratory testing for patients with long-term conditions: a longitudinal cohort study in UK primary care. Fam Pract. 2020;37(6):845–853.

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Competing Interests: None declared.