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[Rational assessment procedure in hypertension]
P Weidmann1, Y Allemann, P Ferrari
1Med. Universitätspoliklinik, Bern.
Insights
Diagnosing hypertension requires careful blood pressure monitoring to distinguish true hypertension from the
Area of Science:
- Cardiology and Public Health
- Clinical Diagnostics
- Risk Factor Assessment
Context:
- Hypertension diagnosis relies on serial blood pressure measurements.
- The 'white coat effect' can elevate readings in medical settings, necessitating further evaluation.
- Borderline or established hypertension often coexists with other cardiovascular risk factors.
Purpose:
- To outline diagnostic criteria for hypertension, including the 'white coat effect'.
- To emphasize the evaluation of associated cardiovascular risk factors in hypertensive patients.
- To guide appropriate etiological investigation strategies for hypertension.
Summary:
- Accurate hypertension diagnosis involves differentiating true hypertension from the 'white coat effect' using methods like self-monitoring or ambulatory profiling.
- Evaluation of cardiovascular risk factors such as smoking, hypercholesterolemia, and diabetes is crucial for both borderline and established hypertension.
- Etiological investigation for hypertension should be individualized, considering patient-specific factors and potential therapeutic benefits.
Impact:
- Early and accurate diagnosis of hypertension significantly improves patient prognosis.
- Distinguishing between essential and secondary hypertension guides targeted therapeutic interventions.
- Optimizing diagnostic and therapeutic efforts enhances patient well-being and socio-economic balance.
Abstract:
Diagnosis of hypertension is based on a classification of blood-pressure values, determined by multiple blood-pressure measurements over a period of several weeks or months. However, possibility of a so-called 'white coat effect' has to be considered, i.e. a marked increase of blood-pressure values in the presence of medical persons. Multiple control-measurements by the patient himself or an ambulatory day profile may clarify the situation in suspicious cases. In the case of pure 'white coat' hypertension, no further investigation is necessary, since cardiovascular complications only correlate with the 'usual' ambulatory blood pressure. Persons with borderline (141-159/91-94 mmHg and intermittently lower, according to the WHO) or established hypertension usually present with further cardiovascular risk factors, like lack of physical exercise, smoking, hypercholesterolemia (elevated total cholesterol/HDL-cholesterol), alone or accompanied by hypertriglyceridemia, disturbed tolerance of glucose or diabetes mellitus, or hypertrophy of the left ventricle. Therefore, in borderline as well as in established hypertension these additional risk factors have to be evaluated. Considering left ventricular hypertrophy electrocardiogram and chest X-ray are insensitive with regard to diagnosis and prognosis of this important and serious risk factor. Echocardiography that can meet both these criteria is for capacity reasons still limited to selected cases. In contrast to the investigation of the risk profile, only few patients will profit from an investigation of etiology of hypertension. It should be tailored to individual features and after thorough evaluation of all consequences, such as costs for the patient, chances for a positive result and possible therapeutical consequences. Usually, careful history taking, clinical investigation and routine laboratory provide an appropriate basis for further rational investigative procedures. Hypertension is a common and important risk factor. The challenge for the public health is great because prognosis can markedly be influenced by early diagnosis and therapy. Insufficient distinction between efficient diagnostic and therapeutical efforts and those that may be superfluous may not only influence psyche and somatic well-being of the patient but also socio-economic balance.