15. Diagnosis of hypertension

Question 1

What is hypertension?

Answer 1

Arterial BP >140/90 mmHg

Question 2

What are the initial steps of assessing hypertensive patients?

Answer 2

• Complete history and physical examination to confirm diagnosis
  
  • Measure blood pressure!
• Screen for other cardiovascular disease risk factors
• Screen for secondary causes of HTN
• Identify cardiovascular consequences of HTN and other comorbidities
  
  • Evaluation of organs that might be affected by HTN
• Determine potential for intervention

Question 3

How do we measure high blood pressure?

Answer 3

Devices:

• Sphygmomanometer mercury device
• Automated oscillometric device

Method:

• BP measurement is done in a sitting position generally.
• It should be done at least 2 times
  
  • Different arm
• The patient shouldn’t be talking during the process
• Measured at least once in the lower limbs if the patient < 30-years-old

Question 4

What is isolated systolic hypertension?

Answer 4

>140/90 if one or both arms are above or equal to that value

It can be seen in hyperthyroidism, for example

Question 5

What are the stages of hypertension?

Answer 5

1. Normal blood pressure: < 120/80 mm Hg.
2. Prehypertension: Systolic pressure is 120-139 mmHg OR Diastolic pressure is 80-89 mmHg. Prehypertension tends to get worse over time.
3. Stage 1 hypertension: Systolic pressure is 140-159 mmHg OR Diastolic pressure is 90-99 mmHg.
4. Stage 2 hypertension: More severe hypertension, Systolic pressure ≥ 160 mmHg OR Diastolic pressure ≥ 100 mmHg.

Question 6

What should be checked during the physical examination?

Answer 6

• BP
• Eyes
  
  • Fundoscopic examination to check for vascular changes
  • Papillary edema
  • Bleeding or cotton wool damage
• Thyroid gland:
  
  • Enlargement
• Heart
  
  • Look for CHD, HF, hypertrophy
  • Auscultation for loud 2nd heart sounds (due to closure of aortic valve)
  • Do an ECG and echo, stress test, angiography (only in patients with chest pain or ECG indication)
• Vascular:
  
  • Doppler US
  • Bruits auscultation over femoral and carotid arteries
  • Palpation of femoral and pedal pulse
• Kidney
  
  • Microalbuminuria

Question 7

What lab tests may help diagnose hypertension?

Answer 7

• Renal
  
  • ​Microscopic urinalysis, albumin excretion, serum BUN and/or creatinin
• Endocrine
  
  • Serum Na⁺, K⁺, Ca²⁺
  • TSH
• Metabolic
  
  • ​Fasting blood glusoe, total cholesterol, HDL, LDL, triglycerides