What labs are necessary for a 14-year-old male with elevated blood pressure (hypertension)?

Laboratory Tests for a 14-Year-Old Male with Elevated Blood Pressure (130/68)

For a 14-year-old male with a blood pressure of 130/68, the recommended laboratory workup should include a comprehensive metabolic panel, complete blood count, lipid profile, urinalysis, and thyroid function tests to assess for underlying causes and potential target organ damage.

Blood Pressure Classification

The patient's blood pressure reading of 130/68 falls into the category of elevated blood pressure for adolescents ≥13 years old, according to current guidelines 1. For adolescents 13 years and older:

• Normal BP: <120/<80 mmHg
• Elevated BP: 120-129/<80 mmHg
• Stage 1 hypertension: 130-139/80-89 mmHg
• Stage 2 hypertension: ≥140/90 mmHg

Since this is a single reading, it's important to note that diagnosis requires confirmation with repeated measurements on at least three separate occasions 2, 1.

Essential Laboratory Tests

Basic Laboratory Panel

1. Complete Blood Count (CBC) 2

   • To assess for anemia or other hematologic abnormalities

2. Comprehensive Metabolic Panel 2

   • Serum creatinine with eGFR
   • Electrolytes (sodium, potassium, calcium)
   • Fasting blood glucose
   • Liver function tests (particularly important in adolescents with obesity) 2

3. Lipid Profile 2

   • Total cholesterol
   • LDL cholesterol
   • HDL cholesterol
   • Triglycerides
   • Should be performed soon after diagnosis 2

4. Urinalysis with Albumin-to-Creatinine Ratio 2

   • To assess for kidney damage and proteinuria
   • Important marker for hypertension-related target organ damage

5. Thyroid-Stimulating Hormone (TSH) 2

   • To rule out thyroid dysfunction as a secondary cause of hypertension

Additional Recommended Tests

1. Hemoglobin A1c 2

   • Particularly important if the patient has risk factors for diabetes or metabolic syndrome

2. Electrocardiogram (ECG) 2

   • To assess for left ventricular hypertrophy or other cardiac abnormalities

3. Renal Ultrasound 2

   • Recommended especially if the patient is under 6 years old or if there's suspicion of renal disease
   • Can help identify structural abnormalities that may contribute to hypertension

Considerations for Mexican Adolescents

The patient's Mexican ethnicity is relevant as racial/ethnic minorities have been identified as having higher risk burden for hypertension-related complications 2. This may warrant particular attention to:

• Sodium intake assessment (dietary history)
• More vigilant screening for target organ damage
• Earlier intervention for elevated blood pressure readings

Follow-Up Recommendations

If initial laboratory tests are normal and blood pressure remains elevated:

• Repeat blood pressure measurements at 3-6 month intervals 1
• Consider ambulatory blood pressure monitoring (ABPM) to rule out white coat hypertension 2
• Focus on lifestyle modifications including reduced sodium intake, increased physical activity, and healthy dietary patterns 1

Warning Signs Requiring Additional Testing

Additional or more specialized testing may be warranted if any of the following are present:

• Severe hypertension (≥140/90 mmHg)
• Family history of early-onset cardiovascular disease
• Abnormal findings on initial laboratory tests
• Signs of target organ damage
• Poor response to standard treatment approaches 2

Remember that elevated blood pressure in adolescents should be taken seriously, as early intervention can prevent long-term cardiovascular complications and target organ damage.