Basic Tests For Initial Evaluation Of Hypertension

Urine for protein, blood, glucose, and microscopic examination

Hemoglobin or hematocrit; leukocyte count

Serum potassium

Serum calcium and phosphate

Serum creatinine or blood urea nitrogen

Fasting glucose

Total. HDL. and LDL cholesterol: triglycerides Electrocardiogram

Consider thyroid-stimulating hormone abdomen for enlarged kidneys, masses, or an enlarged abdominal aorta, evaluation of the lower extremities for edema and perfusion, and a neurologic examination should be standard. Some initial laboratory testing is also indicated (Table 9-3). Counseling patients on lifestyle changes is important at any blood pressure level and includes weight loss, limitation of alcohol intake, increased aerobic physical activity, reduced sodium intake, cessation of smoking. and reduced intake of dietary saturated fat and cholesterol.

Therapy

Initial therapy should be based on the stage or degree of hypertension. For all patients with hypertension, lifestyle modifications should be instituted. For those with prehypertension (blood pressure 120-139/80-89 mmHg), lifestyle modifications are the only interventions indicated unless they have another comorbid condition, such as heart failure or diabetes, which necessitates use of an antihypertensive. Patient with stage I hypertension (blood pressure 140-159/90-99 mmHg) should be started on a single antihypertensive agent, whereas those with stage II hypertension (blood pressure >160 mmHg/>100 mmHg) will need at least two antihypertensives in combination.

For most patients, a low dose of the initial drug of choice should be administered slowly, titrating upward at a schedule dependent on the patient's age. needs, and responses. The target blood pressure typically is 135/85 mmHg, unless the patient has diabetes or renal disease, in which case the target would be lower than 130/80 mmHg. A long-acting formulation that provides 24-hour efficacy is preferred over short-acting agents for better compliance and more consistent blood pressure control. The list of oral and hypertensive drugs is extensive (Table 9^). Because they are associated with a decrease in

Table 9-4

Blood Pressure Health

Blood Pressure Health

Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...

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