Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13

762 Hypertension

tests

Basic Blood Tests

■Hemoglobin/ hematocrit

■BUN/ creatinine

■Potassium (hyperaldosteronism)

■Fasting blood sugar (diabetes mellitus, pheochromocytoma)

■Calcium

■Lipids (stratifies risk for atherosclerosis)

Basic Urine Tests

■Urinalysis: hematuria, proteinuria, casts for possible renal disease,

urinary albumin excretion or albumin/creatinine ratio

Specific Diagnostic Tests

■Blood pressure measurement: Office, portable, ambulatory

➣Cuff with bladder >80% arm circumference

➣Measure 5 minutes after resting comfortably in chair, >30 min-

utes after smoking or coffee ingestion

➣Obtain≥2 BP measurements.

➣Ambulatory BP measurement (ABPM) for patients with variable

BP or to address specific management problems, including ther-

apy or “white coat” HTN; correlates better with end-organ injury;

awake ABPM >135/85 or asleep >120/75 consistent with HTN

➣Arterial BP monitoring in emergent hypertension (inpatient)

■JNC VII classification (when systolic or diastolic differ, select the

greater relative value)

➣Normal <120 and <80

➣Pre-hypertension SBP 120–139 or DBP 80–89

➣HTN-Stage 1 SBP 140–159 or DBP 90–99

➣HTN-Stage 2 SBP≥160 or DBP≥^100

Other Tests as Appropriate

■ECG: highly specific, less sensitive for LVH; “strain-pattern” associ-

ated with poor prognosis

■Echocardiogram: to assess structural heart disease and LV mass

■Renal ultrasound, renal angiography (invasive or non-invasive),

abdominal CT/ MRI for secondary HTN

■Plasma renin activity: rarely clinically useful

differential diagnosis

■Essential (or idiopathic) HTN: 95% cases