What are the initial tests and labs for newly diagnosed Hypertension (HTN)?

From the Guidelines

For a new diagnosis of hypertension (HTN), initial tests and labs should include serum creatinine, eGFR, urine albumin to creatinine ratio (ACR), a 12-lead electrocardiogram (ECG), and a comprehensive metabolic panel to assess kidney function, electrolytes, fasting glucose, and liver function tests. When evaluating a patient with newly diagnosed hypertension, it is essential to consider the potential for target organ damage and secondary causes of hypertension. The following tests are recommended:

• Serum creatinine and eGFR to assess kidney function 1
• Urine ACR to evaluate for kidney damage 1
• A 12-lead ECG to assess for left ventricular hypertrophy or other cardiac abnormalities 1
• A comprehensive metabolic panel to assess kidney function, electrolytes, fasting glucose, and liver function tests 1
• A complete blood count to evaluate for anemia or other blood disorders 1
• Urinalysis to check for protein or blood which may indicate kidney damage 1
• A lipid panel to assess for hyperlipidemia, which often coexists with hypertension 1
• Thyroid function tests, as thyroid disorders can cause secondary hypertension 1
• Consider measuring uric acid levels, as hyperuricemia is associated with hypertension 1 These tests help identify potential causes of secondary hypertension, assess for target organ damage, establish baseline values before starting medications, and identify other cardiovascular risk factors. Additional tests like renal ultrasound, sleep study, or plasma aldosterone/renin ratio may be warranted in certain cases, particularly for patients with resistant hypertension or clinical features suggesting secondary causes 1.

From the Research

Initial Tests and Labs for New Hypertension (HTN)

• The initial evaluation of hypertension involves assessing the level of blood pressure (BP) and the presence of high atherosclerotic cardiovascular disease (CVD) risk 2.
• The decision to initiate antihypertensive medication should be based on the level of BP and the presence of high atherosclerotic CVD risk 2.
• First-line therapy for hypertension is lifestyle modification, including:
  • Weight loss
  • Healthy dietary pattern that includes low sodium and high potassium intake
  • Physical activity
  • Moderation or elimination of alcohol consumption 2
• When drug therapy is required, first-line therapies are:
  • Thiazide or thiazide-like diuretics
  • Angiotensin-converting enzyme inhibitor or angiotensin receptor blockers
  • Calcium channel blockers 2, 3

Laboratory Tests

• There is no specific laboratory test mentioned in the provided studies for the initial evaluation of hypertension.
• However, it is essential to monitor blood pressure levels and adjust treatment accordingly 2.

Treatment Goals

• The goal of treatment is to achieve a blood pressure target of less than 130/80 mm Hg for adults under 65 years and less than 130 mm Hg for adults 65 years and older 2.
• Reducing systolic blood pressure by 10 mm Hg can decrease the risk of CVD events by approximately 20% to 30% 2.