People with hypertension should have the following investigations:
Leung AA, Nerenberg K, Daskalopoulou SS, et al. Hypertension Canada’s 2016 Canadian Hypertension Education Program Guidelines for Blood Pressure Measurement, Diagnosis, Assessment of Risk, Prevention, and Treatment of Hypertension. Can J Cardiol. 2016; 32(5): 569-588. doi: 10.1016/j.cjca.2016.02.066.
Routine laboratory tests that should be performed for the investigation of all patients with hypertension include the following.
i. Urinalysis (Grade D);
ii. Blood chemistry (potassium, sodium, and creatinine) (Grade D);
iii. Fasting blood glucose and/or glycated hemoglobin (Grade D);
iv. Serum total cholesterol, LDL, HDL, non-HDL cholesterol, and triglycerides (Grade D); lipids may be drawn fasting or non-fasting (Grade C) (revised recommendation);
v. Standard 12-lead electrocardiography (Grade C).
Assess urinary albumin excretion in patients with diabetes (Grade D).
All treated hypertensive patients should be monitored according to the current Canadian Diabetes Association guidelines for the new appearance of diabetes (Grade B).
National Institute for Health and Care Excellence (NICE). Hypertension in adults: Diagnosis and management 2011. Available from: nice.org.uk/guidance/cg127. Accessed: August 2017.
For all people with hypertension offer to:
- test for the presence of protein in the urine by sending a urine sample for estimation of the albumin:creatinine ratio and test for haematuria using a reagent strip
- take a blood sample to measure plasma glucose, electrolytes, creatinine, estimated glomerular filtration rate, serum total cholesterol and HDL cholesterol
- examine the fundi for the presence of hypertensive retinopathy
- arrange for a 12-lead electrocardiograph to be performed.
Mancia G, Fagard R, Narkiewicz K, et al. 2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of Arterial Hypertension. J Hypertens. 2013; 31(10): 1925–1938. DOI:10.1097/HJH.0b013e328364ca4c
An ECG is recommended in all hypertensive patients to detect LVH, left atrial dilatation, arrhythmias, or concomitant heart disease.
Measurement of serum creatinine and estimation of GFR is recommended in all hypertensive patients.
Assessment of urinary protein is recommended in all hypertensive patients by dipstick.
Assessment of microalbuminuria is recommended in spot urine and related to urinary creatinine excretion.