Cardiovascular Medicine Book

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Hypertension Evaluation Labs

Aka: Hypertension Evaluation Labs, Hypertension Diagnostic Testing
  1. See Also
    1. Hypertension
    2. Hypertension Causes
    3. Hypertension Evaluation
    4. Hypertension Evaluation History
    5. Evaluation Exam
    6. Isolated Systolic Hypertension
    7. Hypertension Management
    8. Hypertension Risk Stratification
    9. Resistant Hypertension
    10. Antihypertensive Selection
    11. Hypertension Management for Specific Comorbid Diseases
    12. Hypertension Management for Specific Populations
    13. Hypertension Management for Specific Emergencies
    14. Hypertension in Children
    15. Hypertension in Infants
    16. Hypertension in Pregnancy
    17. Hypertension in Athletes
    18. Hypertension in the Elderly
  2. Labs: General for All Patients
    1. Urinalysis
    2. Complete Blood Count (Hemoglobin or Hematocrit minimum)
    3. Fasting lipid profile
      1. Non-Fasting LDL Cholesterol may be sufficient initially
      2. However, high Fasting serum Triglyceride levels (with low HDL Cholesterol) may suggest Metabolic Syndrome
    4. Basic Metabolic Panel (Chem8, SMA7)
      1. Serum Glucose
        1. Fasting Glucose is preferred (esp. if non-Fasting Glucose is abnormal)
      2. Serum Calcium
      3. Serum Potassium
        1. Consider primary Aldosteronism if Hypokalemia (even borderline low)
      4. Serum Creatinine
        1. With calculated Glomerular Filtration Rate (GFR)
        2. Serum Creatinine increased in Renal Artery Stenosis, Renal Failure, renal parenchymal disease
      5. Blood Urea Nitrogen (BUN)
    5. Electrocardiogram
      1. Left Ventricular Hypertrophy
  3. Labs: Optional Studies (as indicated)
    1. Uric Acid
    2. Chest XRay (evaluate for coarctation, heart size)
    3. 24 hour Urine Creatinine
    4. 24 Hour Urine Protein
  4. Evaluation: Secondary Hypertension
    1. Indications
      1. Hypertension Onset under age 30 years (and esp. under age 12) or over age 60 years old
      2. Refractory Hypertension to maximal medical management (especially if previously controlled)
      3. Accelerated Hypertension or Malignant Hypertension
      4. Signs OR symptoms of Secondary Hypertension
    2. Labs
      1. Aortic Coarctation
        1. Arm to leg systolic Blood Pressure difference (abnormal if >20 mmHg)
        2. Chest XRay (notching of the lower rib borders)
        3. Echocardiogram (Children)
        4. MRI Chest (Adults)
      2. Cushing's Disease
        1. 24 hour Urine Cortisol
        2. Late night Salivary cortisol
        3. Low dose Dexamethasone Suppression Test
      3. Pheochromocytoma
        1. 24h Urine Metanephrine
        2. Plasma free metanephrines
      4. Renal parenchymal disease
        1. Serum Creatinine
        2. Urine Protein
        3. Urinalysis with microscopic exam
        4. Renal Ultrasound
      5. Renal Artery Stenosis
        1. Serum Creatinine increased at least 50% over baseline after starting ACE Inhibitor or ARB
        2. Renal bruit may be present on exam
        3. Renal artery doppler Ultrasound (or CT Angiography or MR Angiography)
      6. Primary Aldosteronism (strongly consider if Hypokalemia)
        1. Morning aldosterone to plasma renin ratio >20-30
        2. Serum Potassium decreased
    3. Age-based testing (in addition to general Hypertension labs as above)
      1. Age under 18 years old (renal parenchymal disease, Aortic Coarctation)
        1. Arm to leg systolic Blood Pressure difference (abnormal if >20 mmHg)
        2. Chest XRay
        3. Urinalysis and Urine Culture
        4. Renal Ultrasound
        5. Echocardiogram
        6. Consider Thyroid Stimulating Hormone (TSH)
      2. Age 19 to 39 years old (Thyroid dysfunction, Renal Artery Stenosis due to fibromuscular dysplasia)
        1. Thyroid Stimulating Hormone (TSH)
        2. Renal artery doppler Ultrasound (or CT Angiography or MR Angiography)
        3. Echocardiogram
        4. Consider 24 hour Urine Cortisol
        5. Consider 24h Urine Metanephrine
      3. Age 40 to 64 years old (Hyperaldosteronism, Sleep Apnea, Cushing Syndrome, Pheochromocytoma)
        1. Thyroid Stimulating Hormone (TSH)
        2. Morning aldosterone to plasma renin ratio (abnormal if >20-30)
        3. Consider Sleep Study for Obstructive Sleep Apnea
        4. 24 hour Urine Cortisol
        5. 24h Urine Metanephrine
      4. Age 65 years old and older (Atherosclerotic Renal Artery Stenosis, Renal Failure)
        1. Thyroid Stimulating Hormone (TSH)
        2. Urinalysis
        3. Renal Artery Stenosis imaging (renal artery doppler Ultrasound or MRA or CTA)
        4. Consider 24 hour Urine Cortisol
        5. Consider 24h Urine Metanephrine
  5. References
    1. Charles (2017) Am Fam Physician 96(7): 453-61 [PubMed]

Hypertensive disease (C0020538)

Definition (MEDLINEPLUS)

Blood pressure is the force of your blood pushing against the walls of your arteries. Each time your heart beats, it pumps out blood into the arteries. Your blood pressure is highest when your heart beats, pumping the blood. This is called systolic pressure. When your heart is at rest, between beats, your blood pressure falls. This is the diastolic pressure.

Your blood pressure reading uses these two numbers, the systolic and diastolic pressures. Usually they are written one above or before the other. A reading of

  • 119/79 or lower is normal blood pressure
  • 140/90 or higher is high blood pressure
  • Between 120 and 139 for the top number, or between 80 and 89 for the bottom number is prehypertension

High blood pressure usually has no symptoms, but it can cause serious problems such as stroke, heart failure, heart attack and kidney failure. You can control high blood pressure through healthy lifestyle habits and taking medicines, if needed.

NIH: National Heart, Lung, and Blood Institute

Definition (NCI_CDISC) Pathological increase in blood pressure defined as one of the following: History of hypertension diagnosed and treated with medication, diet, and/or exercise; On at least 2 separate occasions, documented blood pressure greater than 140 mm Hg systolic and/or 90 mm Hg diastolic in patients without diabetes or chronic kidney disease, or blood pressure greater than 130 mm Hg systolic or 80 mm Hg diastolic in patients with diabetes or chronic kidney disease; Currently on pharmacological therapy for the treatment of hypertension.
Definition (NCI) Blood pressure that is abnormally high.
Definition (NCI_CTCAE) A disorder characterized by a pathological increase in blood pressure; a repeatedly elevation in the blood pressure exceeding 140 over 90 mm Hg.
Definition (NCI_NCI-GLOSS) A blood pressure of 140/90 or higher. High blood pressure usually has no symptoms. It can harm the arteries and cause an increase in the risk of stroke, heart attack, kidney failure, and blindness.
Definition (CSP) persistantly high arterial blood pressure.
Definition (MSH) Persistently high systemic arterial BLOOD PRESSURE. Based on multiple readings (BLOOD PRESSURE DETERMINATION), hypertension is currently defined as when SYSTOLIC PRESSURE is consistently greater than 140 mm Hg or when DIASTOLIC PRESSURE is consistently 90 mm Hg or more.
Concepts Disease or Syndrome (T047)
MSH D006973
ICD9 997.91, 401-405.99
ICD10 I10-I15.9, I10, I10-I15
SnomedCT 38341003, 155302005, 194757006, 194760004, 155295004, 194756002, 266287006, 194794002, 195537001
LNC MTHU020789, LA14293-7, LA7444-8
English Hypertension, BLOOD PRESSURE HIGH, HYPERTENSION ARTERIAL, Hypertensive disease NOS, Hypertensive diseases, [X]Hypertensive diseases, Systemic hypertension, Hypertensive disorder, systemic arterial, hyperpiesia, hyperpiesis, systemic HTN, systemic hypertension (diagnosis), systemic hypertension, Hypertension arterial, Blood pressure high, HBP, HT, Hypertension NOS, Surg comp - hypertension, HTN, Hypertension [Disease/Finding], high blood pressure, hypertensive disorder, hypertensive vascular disease, arterial hypertension, arterial hypertension systemic, vascular hypertension, blood high pressure, high blood pressure disorder, systemic arterial hypertension, hypertensive disease, Hypertensive diseases (I10-I15), Complications affecting other specified body systems, not elsewhere classified, hypertension, High Blood Pressure, Hypertensive disease NOS (disorder), Hypertensive disease (disorder), (Hypertensive disease) or (hypertension), (Hypertensive disease) or (hypertension) (disorder), [X]Hypertensive diseases (disorder), hypertension, BLOOD PRESSURE, INCREASED, BLOOD PRESSURE, HIGH, Hypertensive Disorder, HIGH BLOOD PRESSURE, INCREASED BLOOD PRESSURE, HYPERTENSION, PRESSURE, HIGH BLOOD, High blood pressure, Hyperpiesia, Hyperpiesis, Hypertensive vascular degeneration, Hypertensive vascular disease, BP - High blood pressure, High blood pressure disorder, Systemic arterial hypertension, HBP - High blood pressure, BP+ - Hypertension, HT - Hypertension, Hypertensive disorder, systemic arterial (disorder), Hypertensive disorder, HTN - Hypertension, blood pressure; high, high; arterial tension, high; blood pressure, Hypertension, NOS, Hypertensive disease, NOS, Raised blood pressure (disorder), Blood Pressure, High, Blood Pressures, High, High Blood Pressures, Vascular Hypertensive Disorder, Hypertensive disease, HYPERTENSIVE DISEASE
French HYPERTENSION ARTERIELLE, Pression artérielle élevée, PAH, Hypertension SAI, TH, HYPERTENSION, TENSION ARTERIELLE E, Hypertension chronique, Hypertension permanente, Hypertension artérielle, Hypertension
Portuguese HIPERTENSAO, Hipertensão arterial NE, Hipertensão arterial, Pressão arterial alta, HYPERTENSAO ARTERIAL, PRESSAO SANGUINEA ELEVADA, Pressão Arterial Alta, Pressão Sanguínea Alta, Hipertensão
Spanish HIPERTENSION, PRESION SANGUINEA ALTA, Presión sanguínea alta, HTA, Hipertensión NEOM, Hipertensión arterial, HT, HIPERTENSION ARTERIAL, enfermedad hipertensiva, SAI, [X]enfermedades hipertensivas (trastorno), enfermedad hipertensiva, SAI (trastorno), [X]enfermedades hipertensivas, Hypertensive disease NOS, degeneración vascular hipertensiva, enfermedad hipertensiva, enfermedad vascular hipertensiva, hiperpiesia, hiperpiesis, hipertensión arterial (trastorno), hipertensión arterial, presión arterial alta, tensión arterial alta, tensión arterial elevada, Hipertensión, Presión Sanguínea Alta
German HYPERTONIE, Hypertonie, arteriell, Blutdruck, hoch, HBP, HT, Hypertonie NNB, BLUTDRUCK HOCH, HYPERTONIE ARTERIELL, Hypertension, Hypertonie
Dutch hypertensie NAO, hoge bloeddruk, arteriële hypertensie, bloeddruk; hoog, hoog; arteriële druk, hoog; bloeddruk, hypertensie, Bloeddruk, hoge, Hypertensie
Italian Ipertensione (HT), Ipertensione NAS, Pressione del sangue elevata, Ipertensione, Pressione sanguigna alta, Ipertensione arteriosa
Japanese 動脈性高血圧, 高血圧NOS, コウケツアツ, コウケツアツNOS, ドウミャクセイコウケツアツ, 高血圧, 高血圧症
Swedish Högt blodtryck
Czech hypertenze, Arteriální hypertenze, Vysoký krevní tlak, Hypertenze NOS, Hypertenze, vysoký krevní tlak, hypertonie
Finnish Kohonnut verenpaine
Russian GIPERTENZIIA, GIPERTONICHESKAIA BOLEZN', KROVIANOE DAVLENIE VYSOKOE, ГИПЕРТЕНЗИЯ, ГИПЕРТОНИЧЕСКАЯ БОЛЕЗНЬ, КРОВЯНОЕ ДАВЛЕНИЕ ВЫСОКОЕ
Croatian HIPERTENZIJA
Polish Nadciśnienie
Hungarian Arteriás hypertonia, Hypertensio, HT, RR magas, Hypertonia k.m.n., Magas vérnyomás
Norwegian Høyt blodtrykk, Hypertensjon, Hypertoni
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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