Investigate for end organ damage and co-morbidities

Question 1

Investigations for end-organ damage and cardiovascular risk should include

Answer 1

Dipstick urine test for haematuria and proteinuria

Quantification of urinary protein with either:

• an albumin:creatinine ratio (ACR)
• or protein:creatinine ratio (PCR)

Blood eGFR, electrolytes, HbA1c, lipids, urate

Ophthalmoscopic examination of the fundus looking for;

• copper and silver wiring
• AV nipping
• retinal haemorrhages

An ECG to assess for signs of LVH, , previous MI

consider referring for an echocardiogram if secondary causes for hypertension are suspected

Question 2

Recommended routine basic screening tests

Answer 2

Ambulatory monitoring

Urine tests

• urinalysis (for protein, blood and glucose)
• micro-urine (casts, red and white cells)
• urine culture (only if urinalysis abnormal)

Biochemical tests

• potassium and sodium
• creatinine and urea/e GFR
• uric acid
• glucose
• lipids

Chest X-ray

ESR

ECG

Others (e.g. renal ultrasound) only as indicated.

Question 3

Examination

Answer 3

Measure:

• pulse rate, rhythm, and character.
• jugular venous pulse and pressure.
• waist circumference (centimetres) and body mass index (BMI).

Look for evidence of:

cardiac enlargement – displaced apex, extra heart sounds.

decompensation – basal crackles or wheeze on lung auscultation, peripheral oedema, abdominal signs e.g., pulsatile liver.

arterial disease e.g., carotid, renal, or abdominal bruits, AAA, absent femoral pulses, radiofemoral delay.

CKD e.g., palpable kidneys in polycystic kidney disease.

abnormalities of the endocrine system e.g., Cushing syndrome, thyroid disease.

abnormalities of the optic fundi e.g., tortuosity, thickening, or arteriovenous nipping of retinal arteries, retinal haemorrhages, exudates, diabetic retinopathy, papilloedema.

any focal neurological signs, particularly for malignant HTN.