From the Guidelines
To investigate high blood pressure, begin with accurate blood pressure measurements and basic laboratory tests, including complete blood count, comprehensive metabolic panel, lipid profile, thyroid function tests, and urinalysis, as recommended by the 2020 international society of hypertension global hypertension practice guidelines 1.
Initial Evaluation
The initial evaluation of a patient with high blood pressure should include a thorough medical history, physical examination, and routine laboratory tests to assess lifestyle, identify other cardiovascular risk factors, and reveal identifiable causes of high blood pressure 1. The physical examination should include an appropriate measurement of blood pressure, examination of the optic fundi, calculation of body mass index (BMI), auscultation for carotid, abdominal, and femoral bruits, and palpation of the thyroid gland.
Laboratory Tests
Basic laboratory tests should include:
- Complete blood count
- Comprehensive metabolic panel (including electrolytes, creatinine, blood glucose)
- Lipid profile
- Thyroid function tests
- Urinalysis A 12-lead ECG should be performed to assess for left ventricular hypertrophy, as recommended by the 2007 guidelines for the management of arterial hypertension 1.
Additional Tests
Additional tests may include:
- Ambulatory blood pressure monitoring over 24 hours to detect white coat hypertension or masked hypertension
- Home blood pressure monitoring
- Renal ultrasound, plasma aldosterone/renin ratio, 24-hour urinary catecholamines, or sleep studies for patients with suspected secondary hypertension, as recommended by the 2020 international society of hypertension global hypertension practice guidelines 1.
- Screening for subclinical organ damage, including electrocardiography, echocardiography, ultrasound scanning of carotid arteries, and estimation of glomerular filtration rate (GFR) or creatinine clearance, as recommended by the 2007 guidelines for the management of arterial hypertension 1.
Specialized Tests
For patients with suspected secondary hypertension, specialized tests should be carefully chosen based on information from history, physical examination, and basic clinical investigations, as recommended by the 2020 international society of hypertension global hypertension practice guidelines 1. These tests may include:
- Renal ultrasound
- Plasma aldosterone/renin ratio
- 24-hour urinary catecholamines
- Sleep studies
Referral to Specialist Center
Patients with suspected secondary hypertension should be referred to a specialist center with access to appropriate expertise and resources for further investigation and management, as recommended by the 2020 international society of hypertension global hypertension practice guidelines 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Hbp Investigations
- The evaluation of patients with hypertension typically involves a focused history and physical examination, as well as basic tests to determine if the hypertension is primary or secondary, and to assess for target organ damage 2.
- A complete history, physical examination, and simple laboratory procedures such as CBC, urinalysis, SMA-6 and 12, and ECG can yield sufficient information to detect damage to target organs and exclude secondary causes of hypertension 3.
- The use of angiotensin-converting enzyme (ACE) inhibitors has been shown to reverse left ventricular hypertrophy, a common condition associated with hypertension, by reducing afterload and blocking adrenergic action and sympathetic nervous system influences 4, 5.
- ACE inhibitors can play an important role in protecting the heart during the various phases of evolution of hypertensive heart disease, both acutely and on a long-term basis, by reducing cardiac hypertrophy and maintaining normal coronary flow reserve 5.
- In patients with uncontrolled hypertension and left ventricular hypertrophy, the addition of thiazide diuretics or calcium channel blockers to ACEI/ARB-based therapy can produce significant regression of left ventricular hypertrophy, independent of blood pressure reduction 6.
Investigation Findings
- A study of 217 patients with uncontrolled hypertension and left ventricular hypertrophy found that ACEI/ARB-based therapy with add-on thiazide diuretics or calcium channel blockers produced significant reduction in left ventricular mass index, with triple therapy showing the greatest reduction 6.
- Another study found that ACE inhibitors can reduce left ventricular mass and posterior wall and septal wall thickness in hypertensive patients with left ventricular hypertrophy 5.
- The mechanism of regression of left ventricular mass by ACE inhibition is speculative, but may involve the absence of a reflex hyperadrenergic state and interference with angiotensin II generation 5.