Evaluation of Patients With Hypertension
The 2017 ACC/AHA guidelines expanded the recommended procedures for evaluation of patients with hypertension; the recommended evaluation includes an assessment of lifestyle and the identification of other cardiovascular risk factors (Table 3-3), a search for causes of secondary hypertension, and determination of the presence or absence of targetorgan damage and cardiovascular disease.
The physical examination of the patient should include measurement of BP in both arms (from at least 2 readings taken on 2 or 3 different occasions); measurement of orthostatic BP; ophthalmoscopic examination; calculation of body mass index; measurement of waist circumference, which is considered the most important anthropometric factor associated with hypertensive risk; auscultation for carotid, abdominal, and femoral bruits; examination of the thyroid gland; examination of the heart and lungs; examination of the abdomen for masses and aortic pulsation; examination of the lower extremities for edema and pulses; and neurologic assessment.
Laboratory tests to screen for secondary causes and exclude comorbidity (recommended before starting treatment) include an electrocardiogram, urinalysis, complete blood count, and serum chemistry studies, including uric acid tests and a fasting lipid profile. Patients with suspected cardiac morbidities should have a 2-dimensional echocardiogram. More extensive testing for identifiable causes of hypertension is usually not indicated unless BP control is not achieved or if other clinical findings warrant further evaluation.
Table 3-3 Cardiovascular Risk Factors
Berrington de Gonzalez A, Hartge P, Cerhan JR, et al. Body-mass index and mortality among 1.46 million white adults. N Engl J Med. 2010;363(23):2211–2219.
Excerpted from BCSC 2020-2021 series: Section 1 - Update on General Medicine. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.