Background Substantial variation in testing rates in adults with hypertension across UK primary care suggest that patients are not receiving optimal monitoring.

Aim To develop a minimal set of evidence-based blood tests for adults with hypertension.

Design Rapid review, routine data analyses, and consensus study.

Method We developed an initial list of tests which were recommended by guidelines or used commonly. We created filtering questions to examine the rationale of each test. To answer each question, we performed stepwise rapid reviews of evidence cited by guidelines, high-quality studies, systematic reviews, and individual studies. A consensus group, including clinicians and patients, voted to include or exclude each test in the testing panel based on the evidence. If there was no consensus (>80%), additional evidence was sought through rapid reviews or analyses of primary care records, which was subject to further voting.

Results We identified 16 tests that are routinely ordered for people with hypertension. We found consistent and good evidence that eGFR to detect chronic kidney disease and HbA1c to detect diabetes is beneficial for patients. We found no or inconsistent evidence of the benefit of routinely measuring lipids, electrolytes, haemoglobin, thyroid function tests, clotting tests, calcium, ferritin, folate acid, or vitamin B12. We found good evidence that there is no benefit in routinely monitoring liver function, inflammation markers, or brain natriuretic peptide.

Conclusion We identified a minimal set of evidence-based tests that should be offered to adults with hypertension. Implementing these recommendations could reduce harms associated with unwarranted variation in care. Further research is needed to clarify the role of tests with inconsistent evidence and determine the optimal frequency of testing.

What is already known on this topic There is substantial variation in the use of blood tests to monitor people with hypertension suggesting that many patients are not receiving optimal care. Over-testing can cause patient harm, including patient anxiety, unnecessary downstream tests, referrals, and overdiagnosis, as well as wasting limited NHS resources.

What this study adds We have developed a minimal testing panel for patients with hypertension based on the best available evidence and a consensus process. The panel includes eGFR to screen for chronic kidney disease, HbA1c to screen for diabetes mellitus, potassium for patients on ACE inhibiters and angiotensin II receptor blockers.

How this study might affect research, practice or policy – summarise the implications of this study Unnecessary testing could be prevented if guidelines and local protocols recommended minimal testing sets and made clear additional tests should only be added if clinically indicated. Future research needs to address optimal testing intervals and test thresholds.

The authors have declared no competing interest.

This study was supported by National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research (NIHR201616). This research was supported by the NIHR Applied Research Collaboration West (ARC West). The views expressed in this article are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funder was not involved in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Independent Scientific Advisory Committee (ISAC) gave ethical approval for this work on 21/12/2021 (protocol number 21_001671)

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

All data produced during the rapid reviews and consensus meetings are contained in the manuscript or supplementary materials. Part of the study is based on data from the Clinical Practice Research Datalink (CPRD) obtained under licence from the MHRA and NIHR. The data are provided by patients and collected by the NHS as part of their care and support. CPRD data can be accessed via the MHRA: https://www.cprd.com/