Chronic hypertension laboratory findings: Difference between revisions
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{{ | {{Chronic hypertension}} | ||
{{CMG}}; '''Assistant Editor-In-Chief:''' | {{CMG}}; '''Assistant Editor-In-Chief:''' [[User:YazanDaaboul|Yazan Daaboul]], [[User:Sergekorjian|Serge Korjian]] | ||
==Overview== | ==Overview== | ||
Patients identified to be hypertensive must have an initial work-up to identify the presence and extent of target organ damage. Initial work-up is important because it recognizes initial baseline values that can aid the patient and the healthcare provider in assessing the evolution of hypertension and its complications with follow-up visits and lab tests. | Patients identified to be hypertensive must have an initial work-up to identify the presence and extent of target organ damage. Initial work-up is important because it recognizes initial baseline values that can aid the patient and the healthcare provider in assessing the evolution of hypertension and its complications with follow-up visits and lab tests. A more extensive work-up is only indicated when hypertension is not controlled with appropriate therapy or initial laboratory testing suggests a specific etiology of secondary hypertension. | ||
==Laboratory Tests== | ==Laboratory Tests== | ||
Patients identified to be hypertensive must have an initial work-up to identify the presence and extent of target organ damage. Initial work-up is important because it recognizes initial baseline values that can aid the patient and the healthcare provider in assessing the evolution of hypertension and its complications with follow-up visits and lab tests. | |||
'''JNC 7 recommends the following routine laboratory tests before initiation of therapy for hypertension:'''<ref name="pmid16512265">{{cite journal| author=Cuddy ML| title=Treatment of hypertension: guidelines from JNC 7 (the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 1). | journal=J Pract Nurs | year= 2005 | volume= 55 | issue= 4 | pages= 17-21; quiz 22-3 | pmid=16512265 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16512265 }} </ref> | |||
* 12-Lead electrocardiogram (ECG) | |||
* Urinalysis, including urinary albumin excretion or albumin/creatinine ratio | |||
* | * Blood glucose | ||
* | * Blood hematocrit | ||
* | * Serum electrolytes, especially potassium | ||
** | * Serum calcium | ||
** | * Lipid profile: Total cholesterol, LDL, HDL, triglycerides | ||
* Creatinine or equivalent to assess estimated GFR | |||
A more extensive work-up is only indicated when hypertension is not controlled with appropriate therapy or initial laboratory testing suggests a specific etiology of hypertension. | |||
===Diagnostic Tests for Secondary Hypertension=== | ===Diagnostic Tests for Secondary Hypertension=== | ||
Below is a table summarizing the diagnostic tests used in the case of secondary hypertension:<ref name="pmid12748199">{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. | journal=JAMA | year= 2003 | volume= 289 | issue= 19 | pages= 2560-72 | pmid=12748199 | doi=10.1001/jama.289.19.2560 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12748199}}</ref> | Below is a table summarizing the diagnostic tests used in the case of secondary hypertension:<ref name="pmid12748199">{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. | journal=JAMA | year= 2003 | volume= 289 | issue= 19 | pages= 2560-72 | pmid=12748199 | doi=10.1001/jama.289.19.2560 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12748199}}</ref> | ||
{| | {|border="1" style="border-collapse:collapse; text-align:left; font-size:120%;" cellpadding="5" align="center" width="900px" | ||
| ''' | | bgcolor="#67e1ff"|'''Etiology'''||bgcolor="#67e1ff"|'''Diagnostic Tests''' | ||
|'''Diagnostic Tests''' | |||
|- | |- | ||
| | | bgcolor="#f3f3f3"|White coat hypertension | ||
| | | 24-hour holter monitoring | ||
|- | |- | ||
| | | bgcolor="#f3f3f3"|Chronic kidney disease | ||
| | | Serum creatinine, urinalysis, urinary spot albumin, 24 hour urine collection for creatinine and albumin, renal ultrasound, renal biopsy | ||
|- | |- | ||
| | | bgcolor="#f3f3f3"|Coarctation of aorta | ||
| | | CT angiography | ||
|- | |- | ||
| | | bgcolor="#f3f3f3"|Cushing's syndrome | ||
| | | 24-hour urinary cortisol excretion, low-dose dexamethasone suppression test, late evening serum or salivary cortisol, and CRH after dexamethasone test | ||
|- | |- | ||
| | | bgcolor="#f3f3f3"|Drug induced/related hypertension | ||
| 24 hour urinary | | History, Drug/toxicology screening | ||
|- | |||
| bgcolor="#f3f3f3"|Pheochromocytoma | |||
| 24 hour plasma free metanephrines and urinary fractionated metanephrines | |||
|- | |||
| bgcolor="#f3f3f3"|Primary aldosteronism and other mineralocorticoid excess states | |||
| Ratio of plasma aldosterone to plasma renin activity, 24-hour urinary aldosterone levels | |||
|- | |||
| bgcolor="#f3f3f3"|Renovascular hypertension (Renal artery stenosis) | |||
| Doppler flow study, Magnetic resonance angiography | |||
|- | |||
| bgcolor="#f3f3f3"|Sleep apnea | |||
| Polysomnography | |||
|- | |||
| bgcolor="#f3f3f3"|Thyroid/Parathyroid disease | |||
| TSH, Free T3/T4,PTH | |||
|} | |||
==2013 ESH/ESC Guidelines For The Management of Arterial Hypertension (DO NOT EDIT)<ref name="pmid23771844">{{cite journal| author=Authors/Task Force Members. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A et al.| title=2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). | journal=Eur Heart J | year= 2013 | volume= 34 | issue= 28 | pages= 2159-219 | pmid=23771844 | doi=10.1093/eurheartj/eht151 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23771844 }} </ref>== | |||
===Search for Asymptomatic Kidney Diseases (DO NOT EDIT)<ref name="pmid23771844">{{cite journal| author=Authors/Task Force Members. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A et al.| title=2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). | journal=Eur Heart J | year= 2013 | volume= 34 | issue= 28 | pages= 2159-219 | pmid=23771844 | doi=10.1093/eurheartj/eht151 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23771844 }} </ref>=== | |||
{|class="wikitable" align="center" width="900px" | |||
|- | |- | ||
| | | colspan="1" style="text-align:center; background:LightGreen"|[[EHS ESC guidelines classification scheme#Classification of Recommendations|Class I]] | ||
| | |||
|- | |- | ||
| [[ | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''1. '''Measurement of serum [[creatinine]] and estimation of [[GFR]] is recommended in all hypertensive patients. ''([[EHS ESC guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| [[ | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''2. '''Assessment of urinary protein is recommended in all hypertensive patients by dipstick. ''([[EHS ESC guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''3. '''Assessment of [[microalbuminuria]] is recommended in spot urine and related to urinary [[creatinine]] excretion. ''([[EHS ESC guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
|} | |} | ||
Latest revision as of 14:03, 17 May 2017
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Risk calculators and risk factors for Chronic hypertension laboratory findings |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assistant Editor-In-Chief: Yazan Daaboul, Serge Korjian
Overview
Patients identified to be hypertensive must have an initial work-up to identify the presence and extent of target organ damage. Initial work-up is important because it recognizes initial baseline values that can aid the patient and the healthcare provider in assessing the evolution of hypertension and its complications with follow-up visits and lab tests. A more extensive work-up is only indicated when hypertension is not controlled with appropriate therapy or initial laboratory testing suggests a specific etiology of secondary hypertension.
Laboratory Tests
Patients identified to be hypertensive must have an initial work-up to identify the presence and extent of target organ damage. Initial work-up is important because it recognizes initial baseline values that can aid the patient and the healthcare provider in assessing the evolution of hypertension and its complications with follow-up visits and lab tests.
JNC 7 recommends the following routine laboratory tests before initiation of therapy for hypertension:[1]
- 12-Lead electrocardiogram (ECG)
- Urinalysis, including urinary albumin excretion or albumin/creatinine ratio
- Blood glucose
- Blood hematocrit
- Serum electrolytes, especially potassium
- Serum calcium
- Lipid profile: Total cholesterol, LDL, HDL, triglycerides
- Creatinine or equivalent to assess estimated GFR
A more extensive work-up is only indicated when hypertension is not controlled with appropriate therapy or initial laboratory testing suggests a specific etiology of hypertension.
Diagnostic Tests for Secondary Hypertension
Below is a table summarizing the diagnostic tests used in the case of secondary hypertension:[2]
| Etiology | Diagnostic Tests |
| White coat hypertension | 24-hour holter monitoring |
| Chronic kidney disease | Serum creatinine, urinalysis, urinary spot albumin, 24 hour urine collection for creatinine and albumin, renal ultrasound, renal biopsy |
| Coarctation of aorta | CT angiography |
| Cushing's syndrome | 24-hour urinary cortisol excretion, low-dose dexamethasone suppression test, late evening serum or salivary cortisol, and CRH after dexamethasone test |
| Drug induced/related hypertension | History, Drug/toxicology screening |
| Pheochromocytoma | 24 hour plasma free metanephrines and urinary fractionated metanephrines |
| Primary aldosteronism and other mineralocorticoid excess states | Ratio of plasma aldosterone to plasma renin activity, 24-hour urinary aldosterone levels |
| Renovascular hypertension (Renal artery stenosis) | Doppler flow study, Magnetic resonance angiography |
| Sleep apnea | Polysomnography |
| Thyroid/Parathyroid disease | TSH, Free T3/T4,PTH |
2013 ESH/ESC Guidelines For The Management of Arterial Hypertension (DO NOT EDIT)[3]
Search for Asymptomatic Kidney Diseases (DO NOT EDIT)[3]
| Class I |
| "1. Measurement of serum creatinine and estimation of GFR is recommended in all hypertensive patients. (Level of Evidence: B)" |
| "2. Assessment of urinary protein is recommended in all hypertensive patients by dipstick. (Level of Evidence: B)" |
| "3. Assessment of microalbuminuria is recommended in spot urine and related to urinary creatinine excretion. (Level of Evidence: B)" |
References
- ↑ Cuddy ML (2005). "Treatment of hypertension: guidelines from JNC 7 (the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 1)". J Pract Nurs. 55 (4): 17–21, quiz 22-3. PMID 16512265.
- ↑ Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL; et al. (2003). "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report". JAMA. 289 (19): 2560–72. doi:10.1001/jama.289.19.2560. PMID 12748199.
- ↑ 3.0 3.1 Authors/Task Force Members. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A; et al. (2013). "2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)". Eur Heart J. 34 (28): 2159–219. doi:10.1093/eurheartj/eht151. PMID 23771844.