Monitoring a long-term condition such as high blood pressure or diabetes

What monitoring involves

Monitoring is the routine part of living well with a long-term condition. You and your doctor agree a target, measure against it at set intervals, and change treatment only when the numbers or your symptoms call for it. Between reviews, many people take some readings at home.

Many conditions stay silent for years, which is why the checks matter. The World Health Organization estimates that 600 million adults worldwide with high blood pressure do not know they have it, and that only about 23% of adults with the condition have it under control [1].

Monitoring high blood pressure

For adults under 80 with high blood pressure, NICE advises keeping clinic blood pressure below 140/90 mmHg, and below 150/90 mmHg from the age of 80 [2]. Home readings run lower, so the home target for adults under 80 is below 135/85 mmHg, taken as the average of readings during your usual waking hours [2]. NICE also advises an annual review to check your blood pressure and talk through your lifestyle, symptoms and medicines [2].

Home monitoring is worth doing well. In a UK trial of 1,182 people with poorly controlled blood pressure, doctors who adjusted treatment using home readings achieved a systolic pressure about 3.5 mmHg lower after 12 months than those using clinic readings alone [3]. A validated upper arm monitor and a short lesson in using it are enough to begin.

Monitoring type 2 diabetes

HbA1c, a blood test that reflects your average glucose over the past few months, is the main measure. NICE advises testing it every 3 to 6 months until it is stable on unchanging treatment, then every 6 months [4]. The target is agreed with you, and is often 48 mmol/mol, or 53 mmol/mol for people taking a medicine that can cause low blood sugar [4].

The yearly review looks beyond glucose. It covers blood pressure, which NICE advises measuring at least once a year in diabetes [2], and eye screening, to which people should be referred as soon as they are diagnosed [5]. Targets can be relaxed for people who are older or frailer, because pushing glucose too low has its own risks [4].

Monitoring an underactive thyroid

If you take levothyroxine, monitoring is a simple TSH blood test. NICE suggests measuring it every 3 months until the level has settled, meaning 2 similar results within the reference range 3 months apart, and then once a year [6]. The aim is a TSH inside the reference range, without doses high enough to suppress it [6].

Patience helps at the start. If TSH was very high before treatment, it can take up to 6 months to return to the reference range, so the dose is adjusted gradually [6].

Why seeing the same doctor helps

A doctor who has seen your earlier results notices a slow drift that a single reading would hide, and remembers which medicines suited you. A systematic review of 22 studies found that 18 of them linked greater continuity of care with doctors to lower mortality [7]. The studies were observational, so they show an association, though a consistent one across many health systems [7].

Who it is not for, and the risks

Some conditions need a specialist team at the centre of care, including type 1 diabetes, diabetes in pregnancy, advanced kidney disease and heart failure. A GP can work alongside that team and keep your records together, though the specialist plan leads.

Treatment can also go too far. Blood pressure that falls too far can cause dizziness and falls, and tight glucose targets can bring hypoglycaemia, which is why NICE advises judging targets with care for people who are frail [2] [4].

A clinic blood pressure of 180/120 mmHg or higher with chest pain, new confusion, signs of heart failure or acute kidney injury needs same day specialist assessment [2]. If you have chest pain, sudden weakness on one side, difficulty breathing or sudden confusion, call 999 in the UK or the local emergency number [8].

What to bring to each review

A review goes further when the doctor can see the whole picture. Bring as much of this as you have.

• Your home blood pressure or glucose readings since the last visit, with dates
• Your latest blood results, including any taken abroad, with their units
• Every medicine you take, including supplements and anything bought without a prescription
• Any side effects, dizzy spells or low blood sugar episodes
• The target you agreed last time, and whether it still suits your life

How The Wellness can help

A GP appointment gives you time to review your readings, agree targets and plan the next check, and a telephone consultation suits a short review of results. Our Core Wellness blood test includes HbA1c, TSH, lipids and a full blood count, and every result is explained by a doctor. Our clinics on Baker Street in Marylebone and Eccleston Street in Belgravia are open from seven in the morning to nine at night every day, and every doctor is GMC registered.

Membership is for people who want a doctor who knows them, priority access and continuity all year, which suits a condition that needs regular reviews.