Describe the diagnostic approch.
Screen patients using in-office blood pressure measurement.
Confirm elevated values with ABPM or HBPM.
Perform a thorough physical examination and obtain initial laboratory studies.
Stratify patients by cardiovascular risk (using the ASCVD risk estimator tool).
Evaluate for target organ damage.
Consider diagnostic workup for secondary causes of hypertension in patients with:
Abnormalities identified during evaluation for newly diagnosed hypertension
Signs suggestive of secondary hypertension
List indications for screening for hypertension.
Individuals > 40 years of age
Adults of any age with risk factors for primary hypertension
Screening every 3–5 years: individuals 18–39 years of age with previously normal blood pressure (< 130/85 mm Hg) and no risk factors
Describe the method for screening for hypertension.
in-office blood pressure measurement
If elevated, measurements should be repeated on both arms.
Elevated average blood pressure on at least two readings obtained on at least two separate visits supports a diagnosis of hypertension.
∼ 20% of individuals with high blood pressure are unaware they have hypertension.
Describe the diagnostic confirmation.
Out-of-office measurement is recommended in all individuals for confirmation of hypertension before initiating treatment.
Ambulatory blood pressure measurement (ABPM): preferred method
A device measures blood pressure at fixed intervals (e.g., every 15–30 minutes) over 12–24 hours.
Takes measurements while the individual is carrying out normal activities during the day and at nighttime
Home blood pressure monitoring (HBPM): Blood pressure is measured by the individual at periodic intervals.
Patients should be taught to measure their own blood pressure to allow for long-term monitoring and assessment of treatment.
Describe the evaluation of patients with newly diagnosed hypertension.
The initial exam should focus on evaluation for signs indicating secondary hypertension and target organ damage, and the assessment of ASCVD risk.
Physical examination and patient history
Fasting blood glucose
Serum sodium, potassium, and calcium levels
Renal function tests: serum creatinine and eGFR
Lipid profile (HDL, LDL, and triglycerides levels)
Urinalysis and urinary albumin-to-creatinine ratio
Serum uric acid
The initial evaluation should include an assessment for orthostatic hypotension (by measuring blood pressure while sitting and standing), especially in older adults. All adults ≤ 30 years of age with elevated brachial blood pressure should also have their blood pressure measured in their thigh to rule out coarctation of the aorta.