How hypertension is diagnosed

The medical history: in collecting the subject’s history, it is important to know whether there have been people in his or her family with hypertension and whether, among his or her lifestyle habits, there are those that expose him or her to the risk of developing this disease. Important evidence may also emerge from the examination, particularly by measuring weight, height, and waist circumference and by palpating and auscultating the heart and carotid arteries.
The signs and symptoms: high blood pressure may remain completely asymptomatic for a long time or may cause nonspecific symptoms, such as headache, that do not make it easy to detect, as they recall many other possible causes. For these reasons, it is a good idea to repeat the pressure measurement periodically, even when the values are normal, so as to catch any other changes early. Figure 1 shows the European Society of Cardiology Guidelines on how to monitor blood pressure over time, based on the values that are recorded. Measurement of blood pressure done with an appropriate instrument by a competent operator is the one that gives the most reliable results. It is also important to use a cuff that fits your arm size. In addition to sphygmomanometers used by operators, there are semi-automatic and fully automatic ones. The latter can also be used by laypersons and, although less accurate, have the advantage of allowing frequent repetition of the measurement. An important aspect of measuring blood pressure, whether done by health care personnel or administered by a layperson, is that it be done under ideal conditions, with the person seated and relaxed. Speaking of factors that affect assessment outcomes there is the well-known impact of the “white coat,” due to the influence a person experiences from seeing a doctor or other health care provider. It is estimated that in 30-40% of sufferers, blood pressure is higher when measured by health care personnel, while it is normal when assessed independently by the person or with 24-hour monitoring. Note that the opposite can also occur, namely that some people have normal blood pressure when measured by a physician and impaired with the other assessment modalities. When such cases occur, specific approaches should be applied. In general, three consecutive values should be collected each time blood pressure is measured, and the assessments should be repeated at different times of the day, but away from meals, to get an idea of the changes over the 24 hours. To further study changes in blood pressure, it is possible to employ an instrument that records its values for 24 hours while the subject performs usual daily activities.

  • Laboratory tests: in the presence of hypertension, blood concentrations of hemoglobin, glucose, major lipids, sodium and potassium, creatinine, and enzymes indicative of liver function should be evaluated. In addition, hematocrit and erythrocyte sedimentation rate values should be checked, and a urine test should be done.
  • Electrocardiogram and echocardiogram: in a hypertensive subject, it is also important to perform an electrocardiogram and, if this detects alterations, an echocardiogram.
  • Other instrumental examinations: among the instrumental examinations that are important to get a complete picture of any alterations induced by hypertension, especially grade 2 or 3 hypertension, is the fundus examination of the eye, which allows the state of the retinal arteries to be assessed.

The goals of care

In treating hypertension, it is also important to consider the consequences that this disease can have on the cardiovascular system and other organs and systems of the body. In fact, as reported above, hypertension may be completely asymptomatic, and therefore the sufferer may not have adequate motivation for its treatment. For this reason, he or she should be informed about the medium- and long-term health consequences of hypertension.

Sources

  • M Volpe e S Sciarretta. Capitolo 45 L’ipertensione arteriosa. In: Manuale di malattie Cardiovascolari della Società Italiana di Cardiologia.
  • PK Whelton e coll. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary. Hypertension. 2018;71:1269-1324.
  • LJ Visseren e coll. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. European Heart Journal 2021; 00, 1-111.

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