Department of Health

Specialty: Cardiology
Age group: Adult

Direct to an emergency department for:

  • Hypertensive emergency (blood pressure greater than 220/140)
  • Severe hypertension with systolic blood pressure greater than 180 mmHg with any of the following:
    • headache
    • confusion
    • blurred vision
    • retinal haemorrhage
    • reduced level of consciousness
    • seizure(s)
    • proteinuria
    • papilloedema
  • A pregnant woman with pre-eclampsia with uncontrolled severe hypertension (i.e. diastolic blood pressure greater than 110 mmHg or systolic blood pressure greater than 170 mmHg).

Criteria for referral to public hospital specialist clinic services

  • Severe persistent hypertension greater than 180/110
  • Refractory hypertension (blood pressure greater than 140/90) in patients:
    • taking three or more antihypertensive medicines
    • unable to tolerate maximum treatment.

Information to be included in the referral

Information that must be provided

  • Blood pressure measurements, preferably taken on both arms
  • Details of all relevant signs and symptoms
  • Relevant medical history and comorbidities
  • Any treatments previously tried, duration of trial and effect
  • Current and complete medication history (including non-prescription medicines, herbs and supplements and recreational or injectable drugs).

Provide if available

  • History of smoking and alcohol intake
  • Liver function tests
  • Full blood examination results
  • Fasting lipid profile results
  • Estimated glomerular filtration rate (eGFR)
  • Urinalysis results
  • Urine protein test results
  • Renal artery duplex report (if renal artery stenosis is suspected and report is available)
  • Previous 12 lead electrocardiogram (ECG) tracings
  • Echocardiogram report
  • If the person is pregnant or planning pregnancy
  • If the person identifies as an Aboriginal and/or Torres Strait Islander.

Additional comments

The Summary and referral information lists the information that should be included in a referral request.

Consider the possibility of secondary hypertension in younger patients.

See also obstetrics statewide referral criteria for Pre-eclampsia and Maternal medical conditions (which includes referrals for severe, refractory hypertension).

Where appropriate and available the referral may be directed to an alternative specialist clinic or service.

Referral to a public hospital is not appropriate for

Not applicable

Reviewed 27 May 2025

Statewide Referral Criteria

Contact us

Address
50 Lonsdale Street
Melbourne, VIC 3000

Phone
1300 650 172
National Relay Service

Email
plannedcare@health.vic.gov.au

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