"Essential hypertension" means the cause hasn't been found, not that it doesn't exist. This page explains what the Independent Medication Review looks at when blood pressure medication is on your list: what is actually driving your blood pressure, and what that means for your medication.
Investigations are charged separately.
Most people with hypertension are told their blood pressure is high, given a prescription, and seen again in three months for a repeat reading. The question of why it is high is rarely asked systematically.
A 10-minute GP appointment is enough to initiate treatment. It is rarely enough to investigate the underlying drivers: sleep, weight, alcohol, medication side effects, stress patterns, kidney function, aldosterone, thyroid. Not because GPs aren't thorough, but because the system isn't built for that kind of consultation.
That investigation is part of the Independent Medication Review.
Essential hypertension, also called primary hypertension, is defined as elevated blood pressure with no identifiable single underlying cause. It accounts for approximately 90% of hypertension diagnoses.
But "no identifiable single cause" is not the same as "no cause." Most cases of essential hypertension involve a combination of modifiable contributors that have never been systematically assessed together: excess weight, high sodium intake, alcohol, poor sleep, chronic stress, physical inactivity, and, critically, medications the patient is taking for other conditions.
Secondary hypertension, with a specific identifiable cause, accounts for around 10% of cases. The most common causes include primary aldosteronism, renal artery stenosis, obstructive sleep apnoea, thyroid dysfunction, and medication-induced hypertension. These are treatable. They are also underdiagnosed, particularly in patients who were labelled essential at first presentation and never reinvestigated.
The question this review asks is not "do you have high blood pressure?" The answer to that is already known. The question is: what is actually driving it, and what follows from that?
"The diagnosis of essential hypertension too often marks the end of the investigation rather than the beginning of it. The label becomes the answer when it should be the starting point."
Dr Dan Reardon · NHS A&E Doctor · GMC 6098984These are not alternative medicine claims. They are well-evidenced, clinically recognised contributors to elevated blood pressure, many of which can be meaningfully addressed without adding medication.
Excess weight is one of the strongest modifiable drivers of hypertension. A 10kg reduction in body weight can lower systolic BP by 5–20mmHg. The relationship is dose-dependent and clinically significant.
OSA causes repeated sympathetic nervous system activation overnight, driving consistently elevated BP, particularly diastolic. It is substantially underdiagnosed and can cause resistant hypertension that doesn't respond to standard treatment.
NSAIDs, oral contraceptives, decongestants, stimulants, and some antidepressants can all raise blood pressure meaningfully. This is frequently overlooked when the medication was prescribed for an unrelated condition.
Excess aldosterone production from the adrenal glands causes sodium retention and potassium loss, raising blood pressure. It is the most common secondary cause of hypertension and is often missed because routine testing is not standard practice.
Blood pressure that is consistently elevated in clinical settings but normal at home. More common than generally recognised. NICE recommends ambulatory monitoring to confirm diagnosis before treatment begins, though this is not always followed in practice.
Alcohol above 14 units per week raises systolic BP by 7–10mmHg. High sodium intake, common in processed food, drives fluid retention and vascular resistance. Both are reversible causes that rarely get the clinical attention they warrant.
Both hypothyroidism and hyperthyroidism affect blood pressure through different mechanisms. Thyroid function is a standard exclusion in secondary hypertension investigation, but it is not always checked when a patient is simply labelled essential.
Chronic kidney disease and renal artery stenosis are well-recognised secondary causes. More relevant in patients with resistant hypertension, younger patients, or those with a significant family history of renal disease.
Sustained psychological stress drives cortisol and adrenaline elevation, causing vascular constriction and sodium retention. The relationship is real, dose-dependent, and rarely assessed as a clinical variable in standard hypertension management.
Chronically elevated insulin drives sodium retention via the kidneys, activates the sympathetic nervous system, and causes vascular stiffness. Insulin resistance often precedes type 2 diabetes by a decade, and most people with hypertension are metabolically dysregulated without knowing it. HbA1c and fasting insulin are almost never tested as part of a standard hypertension workup. They should be.
Potassium is a direct regulator of vascular tone and counteracts the effect of sodium on blood pressure. The modern diet is simultaneously high in sodium and low in potassium. This imbalance is a clinically significant and reversible driver, yet standard hypertension management rarely goes beyond advice to reduce salt.
Magnesium acts as a natural calcium channel blocker, reducing vascular tone and smooth muscle contractivity. Deficiency is common in the UK population and is rarely checked. When it is, serum magnesium is a poor proxy for intracellular status, meaning a "normal" result may not reflect true sufficiency. Almost no hypertension consultations include magnesium assessment.
"High blood pressure isn't just a number problem. It's a physiology problem. And if you don't fix the drivers, you'll just medicate the symptom."
Dr Dan Reardon · NHS A&E Doctor · GMC 6098984GPs manage blood pressure for millions of patients within a system that allocates ten minutes per appointment and prioritises safe prescribing at scale. That system works well for the majority of cases.
What it cannot easily do is provide a dedicated, structured investigation into the specific drivers of one patient's hypertension (reviewing their full medication list, sleep history, dietary patterns, home readings, and investigation gaps) and produce a written plan that the patient and their GP can both act on.
That is exactly what this review provides. Not a criticism of existing care, but a structured addition to it that saves GP time and gives the patient answers they are not getting from a standard appointment.
Where appropriate, a written summary of findings and recommendations is sent directly to your GP, making the review a clinical collaboration rather than a parallel consultation.
Findings and recommendations documented and shared with your GP with your consent, keeping your care coordinated.
Where further tests are indicated (aldosterone, renin, sleep study, ABPM), recommendations go to your GP to action through NHS pathways where appropriate.
If medication adjustment is indicated, findings are documented clearly so any changes happen in shared care, not in isolation.
Acute blood pressure management, emergency care, and ongoing prescribing remain with your GP and NHS team. This is an investigative review, not a replacement for your primary care relationship.
Answer eight questions and receive a personalised report identifying the most likely contributors to your blood pressure, and what has or hasn't been investigated.
High blood pressure is looked at as part of the Independent Medication Review: what is driving it, what you are taking for it, and whether the two still match.
A 55-minute consultation in person and your written plan. Supervised step-down while you carry the plan out is £99 a month, if you want it: a short check each month, your home readings reviewed, a letter to your GP each time a dose changes, and email in between. It ends when the plan is complete.
Investigations are charged separately, whether they are done privately or through your GP. Supervised step-down is set up after your consultation, not at booking. New or urgent symptoms go to your GP, NHS 111 or 999.
The Independent Medication Review investigates the full picture, across your whole medication list, and produces a written plan for what follows from it.