Chronic hypertension laboratory findings
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor-In-Chief: Yazan Daaboul, Serge Korjian
Overview
Patients identified to be hypertensive must have an initial work-up to identify the presence and extent of target organ damage. Initial work-up is important because it recognizes initial baseline values that can aid the patient and the healthcare provider in assessing the evolution of hypertension and its complications with follow-up visits and lab tests. A more extensive work-up is only indicated when hypertension is not controlled with appropriate therapy or initial laboratory testing suggests a specific etiology of secondary hypertension.
Laboratory Tests
Patients identified to be hypertensive must have an initial work-up to identify the presence and extent of target organ damage. Initial work-up is important because it recognizes initial baseline values that can aid the patient and the healthcare provider in assessing the evolution of hypertension and its complications with follow-up visits and lab tests.
JNC 7 recommends the following routine laboratory tests before initiation of therapy for hypertension:[1]
- 12-Lead electrocardiogram (ECG)
- Urinalysis, including urinary albumin excretion or albumin/creatinine ratio
- Blood glucose
- Blood hematocrit
- Serum electrolytes, especially potassium
- Serum calcium
- Lipid profile: Total cholesterol, LDL, HDL, triglycerides
- Creatinine or equivalent to assess estimated GFR
A more extensive work-up is only indicated when hypertension is not controlled with appropriate therapy or initial laboratory testing suggests a specific etiology of hypertension.
Diagnostic Tests for Secondary Hypertension
Below is a table summarizing the diagnostic tests used in the case of secondary hypertension:[2]
| Etiology | Diagnostic Tests |
| White coat hypertension | 24-hour holter monitoring |
| Chronic kidney disease | Serum creatinine, urinalysis, urinary spot albumin, 24 hour urine collection for creatinine and albumin, renal ultrasound, renal biopsy |
| Coarctation of aorta | CT angiography |
| Cushing's syndrome | 24-hour urinary cortisol excretion, low-dose dexamethasone suppression test, late evening serum or salivary cortisol, and CRH after dexamethasone test |
| Drug induced/related hypertension | History, Drug/toxicology screening |
| Pheochromocytoma | 24 hour plasma free metanephrines and urinary fractionated metanephrines |
| Primary aldosteronism and other mineralocorticoid excess states | Ratio of plasma aldosterone to plasma renin activity, 24-hour urinary aldosterone levels |
| Renovascular hypertension (Renal artery stenosis) | Doppler flow study, Magnetic resonance angiography |
| Sleep apnea | Polysomnography |
| Thyroid/Parathyroid disease | TSH, Free T3/T4,PTH |
2013 ESH/ESC Guidelines For The Management of Arterial Hypertension (DO NOT EDIT)[3]
Search for Asymptomatic Kidney Diseases (DO NOT EDIT)[3]
| Class I |
| "1. Measurement of serum creatinine and estimation of GFR is recommended in all hypertensive patients. (Level of Evidence: B)" |
| "2. Assessment of urinary protein is recommended in all hypertensive patients by dipstick. (Level of Evidence: B)" |
| "3. Assessment of microalbuminuria is recommended in spot urine and related to urinary creatinine excretion. (Level of Evidence: B)" |
References
- ↑ Cuddy ML (2005). "Treatment of hypertension: guidelines from JNC 7 (the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 1)". J Pract Nurs. 55 (4): 17–21, quiz 22-3. PMID 16512265.
- ↑ Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL; et al. (2003). "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report". JAMA. 289 (19): 2560–72. doi:10.1001/jama.289.19.2560. PMID 12748199.
- ↑ 3.0 3.1 Authors/Task Force Members. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A; et al. (2013). "2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)". Eur Heart J. 34 (28): 2159–219. doi:10.1093/eurheartj/eht151. PMID 23771844.