Diagnosis of Antihypertensives
Those with hypertension should have investigations into their general cardiac and cardiovascular health, since hypertension is one aspect of a spectrum of disease that includes atherosclerosis, vascular disease, thromboembolic disease, coronary artery disease, and ischemia in the heart and other organs.
Diagnosis begins with an in-depth history and a thorough physical exam, including a blood pressure.
To make the diagnosis of hypertension, the blood pressure in the office setting must be abnormal on at least 2 readings on at least 2 occasions. If there is doubt to the accuracy due to patient nervousness or other reasons, home monitoring can be done or ambulatory monitoring using wireless technology for prolonged BP monitoring.
The diagnosis of hypertension follows this algorithm:
- Normal blood pressure: Systolic <120 mmHg/ diastolic <80 mmHg.
- Elevated blood pressure: Systolic 120-129 mmHg/diastolic <80 mmHg.
- Hypertension stage 1: Systolic 130-139 mmHg OR diastolic 80-89mmHg
- Hypertension stage 2: Systolic ≥ 140 mmHg OR diastolic ≥ 90 mmHg.
If there is a disparity in category between the systolic and diastolic pressures, the higher value determines the stage.
- CBC: To rule anemia and abnormalities of blood elements, including red blood cells (RBCs) and white blood cells (WBCs), as well as platelets.
- Complete metabolic profile: To screen for liver and kidney disease and electrolyte imbalances, as well as a fasting glucose to identify those at risk for diabetes.
- Clotting studies: To identify those with bleeding disorders.
- Thyroid stimulating hormone (TSH): To rule out secondary hypertension due to a hyperactive thyroid gland.
An ECG will identify co-morbidities such as arrhythmias or ventricular enlargement. In combination with a stress test, it can assess exercise tolerance as well as identify angina with exertion.
If there is hypertension associated with structural abnormalities of the heart or with the heart valves, an ultrasound test is crucial to make the diagnosis.
Ultrasound of arteries or veins can identify atherosclerotic plaques and thrombus formation that puts a hypertensive patient at risk for pulmonary embolism from the veins or organ ischemia/infarction from the arteries, including the heart from coronary artery disease or the brain from carotid artery disease.