Initial evaluation of patients with hypertension: an office procedure

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.