When it comes to hypertension screening, many people are the first to think of a blood pressure monitor. In fact, hypertension cannot be accurately diagnosed through sphygmomanometer measurements alone.
There are many common clinical tests for hypertension, mainly covering physical examination, laboratory tests, genetic analysis and so on. If you want to clarify whether you have hypertension, you can know after doing these tests.
1.Physical examination
A detailed physical examination helps to clarify the development of hypertension, such as organ damage.
Physical examination
(1) Examination items
The items include blood pressure measurement, pulse rate measurement, BMI measurement (body mass index measurement), waist circumference hip circumference, and checking for the presence of problems such as Cushing’s face, neurofibromatous skin spots, hyperthyroidism proptosis sign or lower limb edema.
The carotid artery, thoracic aorta, abdominal artery and femoral artery are also auscultated to clarify the presence of murmurs. Palpation of the thyroid gland is performed to rule out thyroid lesions. A thorough cardiopulmonary examination is also required, as well as examination of the abdomen for cystic kidneys or renal masses, arterial pulsations of the extremities, and neurological signs.
(2) Precautions
Blood pressure measurement is the fundamental first stage in assessing blood pressure level, diagnosing hypertension and observing the effect of treatment. When performing blood pressure measurement, the subject needs to rest quietly for at least 5 minutes before starting to measure the upper arm blood pressure, which is kept in a sitting position and with the upper arm placed at the level of the heart.
For the first consultation, both upper arms should be measured, with the side with the higher blood pressure reading eventually being used as the reference. Pulse rate measurement can be performed at the same time as blood pressure measurement.
2.Laboratory tests
Laboratory tests, as an important aid to the diagnosis of hypertension, cover a wide range of items, and can be divided into basic items, recommended items, and selected items.
Blood test
(1) Basic items
Such as blood biochemistry, including blood potassium, blood sodium, fasting blood sugar, blood lipids, blood uric acid and creatinine and other indicators, as well as blood routine, urinalysis and electrocardiogram. These items are helpful for doctors to judge the patient’s condition and the reasonable selection of antihypertensive drugs.
(2) Recommended items
Echocardiography, urine albumin/creatinine ratio, urine protein quantification, glycated hemoglobin, oral glucose tolerance test, high-sensitivity C-reactive protein, echocardiography, carotid ultrasound, fundus and X-ray chest radiograph. These tests are useful for doctors to determine whether the patient has developed secondary complications, such as left ventricular hypertrophy and renal impairment.
Echocardiography
(3) Selected items
Such as blood homocysteine, plasma renin activity or renin concentration, blood and urine cortisol, blood or urine catecholamines, renal artery ultrasound and angiography, sleep respiratory monitoring, etc. Clinical risk stratification for hypertension can be performed based on the results of such items.
3.Other tests
Since there is some family aggregation in the development of hypertension, genetic analysis can be performed in addition to physical examination and laboratory tests for a clearer diagnosis of hypertension.
The clinical genetic diagnosis of hypertension is only applicable to monogenic inherited hypertension such as Liddle syndrome (pseudoaldosteronism) and glucocorticoid suppressible aldosteronism.
Not every one of the above tests is mandatory, and the choice should be made according to the patient’s actual situation and the doctor’s recommendation to better ensure that no diagnosis is missed and no misdiagnosis is made, while avoiding over-testing.
However, both routine physical examinations and laboratory ancillary tests are performed to select more matching and appropriate antihypertensive drugs and to improve the patient’s treatment outcome.
References
[1]Chinese guidelines for the prevention and treatment of hypertension (2018 revised edition) [J]. Chinese Journal of Cardiovascular,2019,24(1):24-56.
[2]Guidelines for primary care treatment of hypertension (practice version-2019)[J]. Chinese Journal of General Practitioners,2019(08):723-731.
[3]Wu Xiaoqing. Quick reference manual of diet and exercise contraindications for hypertension [M]. Qingdao Publishing House,2018:16-19.