What annual screening is recommended for patients with hypertension?

Annual Screening Recommendations for Patients with Hypertension

Annual screening for patients with hypertension should include basic blood biochemistry, urinalysis, ECG, and assessment for hypertension-mediated organ damage to reduce morbidity and mortality. 1

Core Annual Screening Tests

• Blood Pressure Measurements:

  • Office BP measurements at least annually for all hypertensive patients 1
  • Consider home blood pressure monitoring (HBPM) and/or ambulatory blood pressure monitoring (ABPM) to confirm diagnosis and monitor treatment efficacy 1

• Basic Laboratory Tests:

  • Serum creatinine, estimated glomerular filtration rate (eGFR), and urine albumin-to-creatinine ratio (ACR) 1
  • Basic blood biochemistry including serum sodium, potassium 1
  • Thyroid-stimulating hormone (TSH) 1
  • Lipid profile (total cholesterol, HDL, LDL) 1
  • Fasting glucose or HbA1c 1

• Cardiovascular Assessment:

  • 12-lead ECG for all hypertensive patients 1
  • Repeat ECG when patients present with irregular pulse or cardiac symptoms 1

Assessment for Hypertension-Mediated Organ Damage (HMOD)

• Kidney Function:

  • Annual monitoring of serum creatinine, eGFR, and urine ACR if moderate-to-severe chronic kidney disease (CKD) is present 1
  • Consider renal ultrasound in patients with CKD to assess kidney structure and exclude renoparenchymal and renovascular hypertension 1

• Cardiac Assessment:

  • Echocardiography is recommended when ECG is abnormal, murmurs are detected, or cardiac symptoms are present 1
  • Consider coronary artery calcium (CAC) scoring when it may change patient management 1

• Vascular Assessment:

  • Consider carotid or femoral artery ultrasound to assess for atherosclerotic plaque 1
  • Consider ankle-brachial index to assess for peripheral arterial disease 1

Screening for Secondary Hypertension

• Basic Screening:

  • Thorough assessment of history, physical examination, basic blood biochemistry, and urinalysis 1
  • Consider screening for primary aldosteronism by measuring renin and aldosterone in all adults with confirmed hypertension 1

• Consider Additional Screening in patients with:

  • Early onset hypertension (<30 years of age) 1
  • Resistant hypertension 1
  • Sudden deterioration in BP control 1
  • Hypertensive urgency or emergency 1
  • High probability of secondary hypertension based on clinical clues 1

Cardiovascular Risk Assessment

• Annual assessment of 10-year cardiovascular disease (CVD) risk using appropriate risk calculators:
  • SCORE2 for patients aged 40-69 years 1
  • SCORE2-OP for patients aged ≥70 years 1
  • Consider SCORE2-Diabetes for patients with type 2 diabetes 1

Special Considerations

• For Resistant Hypertension:

  • Consider referral to specialized hypertension centers for further testing 1
  • Consider objective evaluation of medication adherence (directly observed treatment or drug level measurement) 1

• For Pregnant Women with Hypertension:

  • More frequent monitoring is required throughout pregnancy 1
  • History of pregnancy complications should be considered as sex-specific risk modifiers 1

Common Pitfalls to Avoid

• Inadequate Frequency: Failing to screen at least annually can miss progression of target organ damage 1
• Overlooking Secondary Causes: 5-10% of hypertensive patients have identifiable secondary causes that may be treatable 1
• Pseudoresistance: Not accounting for white coat effect, poor measurement technique, or medication non-adherence when BP appears uncontrolled 1, 2
• Incomplete Risk Assessment: Focusing solely on BP values without considering overall cardiovascular risk profile 1

By implementing comprehensive annual screening, clinicians can better identify target organ damage early, assess cardiovascular risk, and optimize treatment strategies to reduce morbidity and mortality in patients with hypertension.