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Initial evaluation of patients with hypertension: an office procedure
Insights
Initial high blood pressure evaluations can be streamlined by focusing on target organ damage and secondary causes. Extensive testing is reserved for specific cases, reducing costs and patient risk.
Area of Science:
- Cardiology
- Nephrology
- Internal Medicine
Background:
- Traditional hypertension evaluation involves extensive testing to exclude secondary causes.
- These comprehensive assessments are costly, time-consuming, and carry inherent patient risks.
Purpose of the Study:
- To evaluate the efficacy of a focused initial assessment for hypertension.
- To determine if a less exhaustive approach can adequately identify secondary causes and target organ damage.
Main Methods:
- Review of patient history and physical examination findings.
- Utilization of basic laboratory tests including complete blood count (CBC), urinalysis, SMA-6 and 12, and electrocardiogram (ECG).
Main Results:
- Basic evaluations sufficiently detect target organ damage from hypertension.
- These methods adequately exclude the presence of most secondary causes of hypertension.
Conclusions:
- A focused initial evaluation for hypertension is effective and efficient.
- Extensive testing should be reserved for patients with specific indications, such as suspected secondary causes or treatment resistance.
Abstract:
Traditionally the initial evaluation of a patient with high blood pressure has focused on exluding secondary correctable causes of hypertension. Such all-inclusive evaluations are expensive, time-consuming, and expose the patient to some risk. A complete history, physical examination, and relatively simple laboratory procedures such as CBC, urinalysis, SMA-6 and 12, and ECG yield sufficient information to detect damage to target organs caused by elevated blood pressure and to exclude the presence of secondary causes fairly adequately. In that small number of patients in whom clues for correctable causes of hypertension are uncovered, or if patients fail to respond to appropriate treatment for essential hypertension, a more extensive evaluation can be undertaken.