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Hypertension: investigation, assessment and diagnosis
1University Department of Medicine and Therapeutics, Gardiner Institute, Western Infirmary, Glasgow, UK.
Insights
For mild to moderate hypertension, a basic investigation schedule is sufficient, focusing on cardiovascular risk factors and organ damage. Detailed tests are reserved for specific patient groups or severe cases.
Area of Science:
- Cardiology
- Nephrology
- Internal Medicine
Background:
- Mild to moderate hypertension often requires a simplified investigation approach.
- Cardiovascular risk factors and target organ damage necessitate profiling.
- Screening for secondary hypertension can be limited in many cases.
Purpose of the Study:
- To outline an appropriate investigation schedule for mild to moderate hypertension.
- To identify specific patient groups requiring more detailed investigations.
- To differentiate between primary and secondary causes of hypertension and resistance to treatment.
Main Methods:
- History taking and physical examination.
- Repeated blood pressure measurements and body mass index calculation.
- Routine blood chemistry, urinalysis, and random cholesterol levels.
Main Results:
- A basic set of investigations is adequate for most mild to moderate hypertension cases.
- Detailed investigations are reserved for patients with specific conditions like peripheral vascular disease, abnormal renal function, significant proteinuria, or hypokalemia.
- Resistance to treatment is frequently linked to non-compliance, NSAID use, or alcohol abuse rather than secondary hypertension.
Conclusions:
- A targeted, less intensive investigation strategy is appropriate for mild to moderate hypertension.
- Early identification of risk factors and organ damage guides management.
- Secondary causes and treatment resistance require careful consideration in specific clinical scenarios.
Abstract:
Patients with mild to moderate hypertension require only a simple schedule of investigations, especially if there is a history of stroke or hypertension in first degree relatives. Tests are necessary to profile other cardiovascular risk factors and to detect target organ damage with only limited screening for secondary hypertension. Careful history, physical examination, repeated blood pressure measurements over months and measurements of body mass index, random cholesterol, routine blood chemistry and urinalysis using impregnated paper strips are all that are required. More detailed investigations can be reserved for special groups such as those with peripheral vascular disease or abnormal renal function before or after treatment with angiotensin converting enzyme inhibitors or significant proteinuria or hypokalaemia. Patients with essential hypertension who are smokers with lipid abnormalities may go on to develop superimposed renovascular disease. Severe hypertension at any age and especially if there is a reliable negative family history also merits special consideration. Resistance to antihypertensive treatment is more often due to non-compliance or non-steroidal anti-inflammatory drug use or alcohol abuse than to underlying secondary causes.