Chronic hypertension laboratory findings: Difference between revisions
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Below is a table summarizing the diagnostic tests used in the case of secondary hypertension:<ref name="pmid12748199">{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. | journal=JAMA | year= 2003 | volume= 289 | issue= 19 | pages= 2560-72 | pmid=12748199 | doi=10.1001/jama.289.19.2560 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12748199}}</ref> | Below is a table summarizing the diagnostic tests used in the case of secondary hypertension:<ref name="pmid12748199">{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. | journal=JAMA | year= 2003 | volume= 289 | issue= 19 | pages= 2560-72 | pmid=12748199 | doi=10.1001/jama.289.19.2560 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12748199}}</ref> | ||
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Revision as of 00:38, 5 November 2013
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Hypertension Main page |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor-In-Chief: Taylor Palmieri, 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. Diabetes and raised cholesterol levels being additional risk factors for the development of cardiovascular disease are also tested for as they will also require management.
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.