Laboratory Testing for Hypertensive Patient
For this 57-year-old male with hypertension, order the following essential labs: comprehensive metabolic panel (sodium, potassium, creatinine with eGFR, fasting glucose), lipid profile, complete blood count, TSH, urinalysis with dipstick, and obtain a 12-lead ECG. 1
Core Laboratory Panel
The following tests are mandatory for all newly diagnosed or established hypertensive patients to assess cardiovascular risk, detect target organ damage, and screen for secondary causes:
Basic Blood Tests
- Comprehensive metabolic panel including sodium, potassium, serum creatinine with estimated glomerular filtration rate (eGFR) 1
- Fasting blood glucose to screen for diabetes, present in 15-20% of hypertensive patients 1
- Lipid profile (total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides) as dyslipidemia occurs in 30% of hypertensive patients 1
- Complete blood count (hemoglobin/hematocrit) 1
- Thyroid-stimulating hormone (TSH) to exclude thyroid-related hypertension 1
Urine Testing
- Urinalysis with dipstick to screen for proteinuria and hematuria indicating renal damage 1
Electrocardiogram
- 12-lead ECG to detect atrial fibrillation, left ventricular hypertrophy, and ischemic heart disease 1
Optional Additional Tests
Consider these tests based on clinical context and initial findings:
Enhanced Risk Stratification
- Urinary albumin-to-creatinine ratio for more sensitive detection of early kidney damage 1
- Serum uric acid as hyperuricemia occurs in 25% of hypertensive patients and increases cardiovascular risk 1
When Secondary Hypertension is Suspected
Given this patient's age (57 years), routine screening for secondary causes is not indicated unless specific clinical clues are present. However, be alert for:
- Aldosterone-to-renin ratio if unprovoked hypokalemia, resistant hypertension (requiring >3 medications), or muscle weakness is present 2, 3
- Plasma free metanephrines if episodic symptoms (sweating, palpitations, headaches) suggest pheochromocytoma 1, 3
- Renal artery imaging if flash pulmonary edema, abdominal bruits, or asymmetric kidney size is detected 1, 3
Critical Clinical Context
Why These Tests Matter
More than 50% of hypertensive patients have additional cardiovascular risk factors that proportionally increase risk of coronary, cerebrovascular, and renal disease 1. At 195 pounds, this patient may have metabolic syndrome components (present in 40% of hypertensives), making comprehensive metabolic and lipid assessment essential 1.
Common Pitfalls to Avoid
- Don't skip urinalysis: It is the single most sensitive screening test for renal damage and can detect clinically silent kidney injury 4
- Don't assume normal exam excludes organ damage: End-organ damage is often clinically silent and present in 5-33% of asymptomatic patients 4
- Review medications first: Before extensive workup, ensure hypertension isn't drug-induced (NSAIDs, decongestants, supplements) 2, 3
Monitoring During Treatment
Once treatment begins, monitor serum sodium and potassium during diuretic or RAS blocker titration, and track serum creatinine and urinary albumin as markers of chronic kidney disease progression 1.