After the diagnosis of hypertension, patients are often asked to do a series of tests, and draw blood, and spend money, many patients do not understand this, “high blood pressure, give me some antihypertensive drugs on the line?” . In fact, not, the diagnosis of hypertension is only the first step, to clarify the cause, grasp the condition, guide the treatment is more important, the purpose of these tests are no more than the following three aspects: 1, to clarify the cause of abnormally high blood pressure, to identify primary and secondary hypertension; 2, to clarify the severity of hypertension, to understand the heart, brain, kidneys and other important organs by the damage of hypertension, in order to timely control, delay its 3, to clarify the presence of other comorbidities such as hyperlipidemia, diabetes mellitus, gout, etc., to provide a basis for reasonable individualized drug use. To this end, patients generally need the following routine tests: 1. ECG, echocardiogram and X-ray chest radiograph: to determine the functional status of the heart in patients with hypertension and to determine whether there is cardiomegaly, myocardial strain or combined coronary artery disease. 2. 2, Fundus examination: to understand the small arterial lesions, such as retinal small arteries are generally or locally narrowed, indicating moderate damage to small arteries; retinal hemorrhage or exudation, or the occurrence of optic papillary edema, indicating the severity of vascular damage. In conclusion, hypertensive retinopathy can reflect the severity of hypertension and objectively reflect the degree of damage to the peripheral small vessel lesions, fundus examination is helpful for clinical diagnosis, treatment and prognosis estimation. 3, routine urine examination: to understand whether there is early kidney damage, whether hypertension is caused by kidney disease, and whether accompanied by diabetes, etc.. If there is a large amount of urine protein, red blood cells, white blood cells and tubular type in the urine, secondary hypertension due to chronic nephritis or pyelonephritis should be considered; if there is only a small amount of urine protein and a small amount of red blood cells, it suggests that the kidney damage may be caused by primary hypertension; if urine sugar is found, further investigation of blood sugar is needed to determine whether diabetes is present. In order to avoid errors, the urine specimen should be retained in a clean container, take the first urine early in the morning (middle urine) and promptly sent for testing; female patients should avoid menstruation and leave the middle urine for urine examination. If the urine protein test is negative, urine microalbumin and β2 microglobulin can also be measured, which is more sensitive and can detect hypertensive kidney damage early, as well as early prevention and treatment. 4, blood biochemical examination: including urea nitrogen, creatinine, electrolytes, blood lipids, blood sugar, blood uric acid, blood viscosity, etc., to help clarify whether hypertension is caused by kidney disease.
To determine the extent of hypertension on the kidney, the presence of certain risk factors and comorbidities, such as hyperlipidemia, diabetes mellitus, hyperuricemia, etc. 5, other tests: 24-hour ambulatory blood pressure measurement can record the blood pressure of the normal state of life around the clock, to understand the circadian blood pressure rhythm, so as to reasonably guide the time and dose of medication, the general patients need to do this test (its significance is detailed in the “why also measured 24-hour ambulatory blood pressure” chapter). In addition, to exclude secondary hypertension, some special tests are often required, such as plasma renin, aldosterone, blood and urine catecholamines and their metabolites, blood and urine cortisol and urinary 17-hydroxycorticosteroids, adrenal B
Ultrasound, CT, MRI, vascular Doppler ultrasound carotid, renal and cerebral arteries, angiography, etc. These tests are highly specialized and should be performed under the guidance of a specialist.