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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Box 1. Testing purpose and filtering questions

Testing purpose	Filtering question
Screen for secondary conditions	Are people with the long-term condition at an increased risk of developing the secondary condition that the test is able to detect? Is there anything the clinician can do to manage or treat this? Are there clear benefits of earlier detection or treatment?
Detect adverse treatment effects	Are people using these medications at an increased risk of developing the side effect that the test is able to detect? Is there anything the clinician can do to manage or treat this? Are there clear benefits of earlier detection or treatment?

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Box 2. Quality of evidence

Quality judgement	Level of evidence
Good	High-quality systematic reviews and/or high-quality studies with large sample sizes
Moderate	Systematic reviews with some quality concerns and/or several primary studies showing similar results but some may have quality concerns
Weak	A single primary study with a small sample size with or without quality concerns or several single primary studies with conflicting results

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Table 1. Tests to screen for secondary conditions — answers to filtering questions

Blood test pane, test	Condition targeted by test	Are people with hypertension at increased risk?	Can you intervene?	Benefits of earlier detection?	CM outcomes	Final decision
Renal function tests	Chronic kidney disease		Yes (RR: 1 GL)	Yes (RR: 2 GL)
eGFR		Yes (good evidence from RR: 1 GL, 3 SR, 2PS)			CM1 88% include	Include
Blood urea nitrogen		Yes (weak evidence from additional RR: 3 PS			CM1 more evidence needed CM2 90% exclude	Exclude
HbA1C	Type 2 diabetes mellitus	Yes (good evidence from RR: 1 GL, 1 SR, 3 PS+ additional RR post CM1: 2 SR 1 PS)	Yes	Yes	CM1 more evidence needed CM2 100% include	Include
Blood electrolyte tests
Potassium	Hyper- or hypokalaemia	Conflicting (moderate evidence from RR of increased risk: 1 GL, 1 SR; additional IA no association)	Yes (RR: 1 GL; 1 PS)	Yes	CM1 more evidence needed CM2 100% exclude	Exclude
Sodium	Hyper- or hyponatraemia	No evidence from RR; Yes from additional IA	No	NA	CM1 more evidence needed CM2 100% exclude	Exclude
Lipid profile	Dyslipidaemia and assess cardiovascular risk	Yes (good evidence from RR: 1 GL, 3 SR, 2 PS)	Yes (RR: 1 GL; TT weak evidence) Additional RR on effect of lipid profile tests on behaviour (2 SR; 1PS) and TT found inconsistent evidence	Yes (1 GL)	CM1 more evidence needed CM2 90% exclude	Exclude
Serum cholesterol
High-density lipoprotein
Low-density lipoprotein
Triglycerides
Liver function tests	Metabolic dysfunction-associated steatotic liver disease (MASLD)	Unclear (weak conflicting evidence from RR: 1 SR, 2 PS)	No, other than lifestyle advice (1 GL)*	NA	CM1 100% exclude	Exclude
Albumin
Alkaline phosphatase
Alanine aminotransferase
Aspartate aminotransferase
Bilirubin
Gamma glutamyl transpeptidase
Total protein
Haemoglobin (full blood count)	Anaemia	No evidence	Yes (RR: 1 GL)	Yes (RR: 1 GL)	CM1 88% exclude
Haematinics	Anaemia and deficiency type	No evidence	Yes (RR: 1 GL)	Yes (RR: weak evidence 1 PS)	CM1 88% exclude	Exclude
Vitamin B12
Serum ferritin
Folate tests
Clotting tests		No evidence	No evidence	No evidence	CM1 88% exclude	Exclude
Prothrombin time	Bleeding disorders
Partial thromboplastin time	Hyper- or hypocalcaemia
Thrombin time	Deficiencies and anaemias
Bone profile	Serum calcium and phosphorus levels, vitamin D deficiency, parathyroid problems		Yes (RR: 1 GL)	No evidence	CM1 88% exclude	Exclude
Serum inorganic phosphate		No evidence
Calcium/adjusted calcium		No evidence
Vitamin D		Yes (weak conflicting evidence from RR: 1 PS)
Alkaline phosphatase		No evidence
Parathyroid hormone		No evidence
Thyroid function tests	Hyper- or hypothyroidism	No evidence	Yes (RR: 1 GL)	No evidence	CM1 86% exclude
Thyroxine
Free thyroxine
Thyroid stimulating hormone
Triiodothyronine
B-type natriuretic peptide	Heart failure	Yes (weak evidence from RR: 1 GL, 1 PS).	Yes (RR: 1 GL)	No evidence	CM1 88% exclude	Exclude
Inflammatory markers	General marker for inflammation	Yes (good evidence)	No	NA	Excluded before CM1 owing to lack of consensus on treatment	Exclude
C-reactive proteinand erythrocyte sedimentation rate

CM = consensus meeting. CM1 = first CM. CM2 = second CM. eGFR = estimated glomerular filtration rate. GL = . HbA1C = glycosylated haemoglobin. IA = . PS = . RR = . SR = .

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Table 2. Tests to screen for adverse treatment effects of antihypertensives for patients on stable treatment — overview of answers to filtering question and consensus meeting outcomes

Test panel, test	Condition targeted by test	Are people on these medications at increased risk?	Can you intervene?	Benefits of earlier detection?	CM outcomes	Final decision
HbA1C	Type 2 diabetes mellitus
		No (good evidence) for ACE, ARBs, CC			CM1: 89% exclude	Exclude
		Yes for TTDs (good evidence)	Yes (change medications)	Yes (change medications sooner)	CM1: 89% include for TTDs	Include
Renal function tests	Kidney injury	No evidence for CCBs or TTDs ACEis and ARBs: inconsistent (moderate evidence from RR: 2 SR)	Yes (change medications)	Yes (change medications sooner)	CM1 more evidence needed CM2 80% exclude	Exclude
eGFR
Urea
Blood electrolyte tests
Potassium	Hyper- or hypokalaemia	ACEis and ARBs: Yes (good evidence) No evidence for CCBs, RRD, or TTDs	Yes (change medications)	Yes (change medications sooner)	CM1 more evidence needed CM2 80% include	Include
Sodium	Hyper- or hyponatraemia	Yes for TTDs	Yes (change medications)	Yes (change medications sooner)	CM1: not considered CM2: 80% include	Include
Liver function tests	Liver disease and damage	No evidence; consensus that people with HTN not at increased risk of these side effects than others taking drugs			CM1 100% exclude CM2 100% exclude	Exclude
Albumin
Alkaline phosphatase
Alanine aminotransferase
Aspartate aminotransferase
Bilirubin
Gamma glutamyl transpeptidase
Total protein
Haematinics	Anaemia and deficiency type	No evidence			CM1 100% exclude CM2 100% exclude	Exclude

ACEi = angiotensin-converting enzyme inhibitor. ARB = angiotensin II receptor blocker. CM = consensus meeting. CM1 = first CM. CM2 = second CM. CCB = calcium channel blocker. eGFR = estimated glomerular filtration rate. HbA1C = glycosylated haemoglobin. HTN = . RR = . RRD = . SR = . TTD = thiazide-type diuretic.

Supplementary Data

Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy.