What laboratory tests should be done regularly for someone with Hypertension (HTN) and Diabetes?

Regular Laboratory Testing for Patients with Hypertension and Diabetes

For patients with both hypertension and diabetes, regular laboratory monitoring should include sodium, potassium, serum creatinine with eGFR, lipid profile, fasting glucose, HbA1c, and urinary albumin-to-creatinine ratio at least annually. 1

Core Laboratory Tests

Basic Tests (Every Visit/Annually)

• Renal Function Assessment:

  • Serum creatinine with eGFR calculation 1
  • Urinary albumin-to-creatinine ratio (ACR) 1, 2

• Electrolytes:

  • Sodium 1
  • Potassium (especially important for patients on ACE inhibitors, ARBs, or diuretics) 1

• Diabetes Monitoring:

  • Fasting blood glucose 1
  • Hemoglobin A1c 1, 3

• Lipid Profile:

  • Total cholesterol, LDL-C, HDL-C, triglycerides 1

Additional Tests (As Clinically Indicated)

• Serum uric acid levels 1
• Liver function tests 1

Frequency of Testing

• Initial Diagnosis: Complete panel of all tests listed above
• Follow-up Testing:
  • For stable patients: Annual comprehensive testing
  • For patients with abnormal results or medication changes: More frequent monitoring
  • For patients with moderate-to-severe CKD: At least annual testing of creatinine, eGFR, and ACR 1
  • For patients on ACE inhibitors, ARBs, or diuretics: Monitor renal function and potassium within first 3 months of initiation, then every 6 months if stable 1

Clinical Importance of Regular Testing

Regular laboratory monitoring is crucial for several reasons:

1. Early Detection of Organ Damage:

   • Kidney function tests can detect early diabetic nephropathy and hypertension-mediated organ damage (HMOD) 1
   • Albuminuria is an early marker of kidney damage and cardiovascular risk 2

2. Medication Safety Monitoring:

   • Potassium levels need monitoring with ACE inhibitors, ARBs, and diuretics 1
   • Renal function may deteriorate with certain antihypertensive medications 1

3. Risk Factor Management:

   • Lipid profile helps assess cardiovascular risk 1
   • Glycemic control assessment through HbA1c 1, 3

Common Pitfalls to Avoid

• Underutilization of Testing: Only 35% of hypertensive patients receive albumin-to-creatinine ratio testing within a year of diagnosis, despite its importance 2
• Inconsistent Monitoring: While 74.3% of patients with hypertension receive at least one recommended test, only 42.3% receive all recommended tests 4
• Overlooking Electrolyte Monitoring: Failure to monitor potassium and renal function when using ACE inhibitors, ARBs, or diuretics can lead to dangerous electrolyte imbalances 1
• Missing Albuminuria Testing: This is particularly important for early detection of kidney disease in both conditions 1, 2

Special Considerations

• Older Adults: Laboratory abnormalities are more common in older patients and those with multiple comorbidities 4
• Medication Adjustments: Laboratory results may necessitate medication adjustments to prevent adverse effects while maintaining control of both conditions 1
• Cardiovascular Risk Assessment: Laboratory results contribute to overall cardiovascular risk assessment, which should guide treatment intensity 1

By following this structured laboratory monitoring approach, clinicians can optimize the management of patients with both hypertension and diabetes, potentially reducing morbidity and mortality while improving quality of life.