People with hypertension have an examination performed, including:
National Heart Foundation of Australia. Guideline for the diagnosis and management of hypertension in adults – 2016. Melbourne: National Heart Foundation of Australia, 2016.
Table 4.7, Page 21
Table 4.9, Page 23
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.
If the visit 1 mean non-AOBP or AOBP measurement is high (thresholds outlined in section I, Recommendation 3), a history and physical examination should be performed and, if clinically indicated, diagnostic tests to search for target organ damage (Supplemental Table S4)
and associated cardiovascular risk factors SupplementalTable S5) should be arranged within 2 visits. Exogenous factors that can induce or aggravate hypertension should be assessed and removed if possible (Supplemental Table S6). Visit 2 should be scheduled within 1 month (Grade D).
1. 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 haemoglobin (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).
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.
While waiting for confirmation of a diagnosis of hypertension, carry out investigations for target organ damage (such as left ventricular hypertrophy, chronic kidney disease and hypertensive retinopathy) (see recommendation 1.3.3) and a formal assessment of cardiovascular risk using a cardiovascular risk assessment tool (see recommendation 1.3.2).
If hypertension is not diagnosed but there is evidence of target organ damage such as left ventricular hypertrophy, albuminuria or proteinuria, consider carrying out investigations for alternative causes of the target organ damage.
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
Examination of the retina should be considered in difficult to control or resistant hypertensive patients to detect haemorrhages, exudates, and papilloedema, which are associated with increased CV risk.
Examination of the retina is not recommended in mild-to-moderate hypertensive patients without diabetes, except in young patients.