Diagnosis of Hypertension

Hypertension is objectively diagnosed by automated electronic devices OR conventional sphygmomanometer with stethoscope.

Why automated electronic devices is preferred toward conventional sphygmomanometer?

Automated electronic devices is preferred toward the other because of reproducibility of results and no variability in measuring the blood pressure. Easy to use and no chances of observer bias that’s why preferred towards conventional sphygmomanometer.

How we measure the blood pressure in hypertension?

How we measure the blood pressure of hypertensive patients?

For measuring the blood pressure patient should be

• properly seated with back support
• empty bladder
• Shouldn’t use caffeine (coffee) or nicotine (tea) in the last 30 minutes
• Feet should be underground,  straight and uncrossed
• Arms should at the level of heart and place on the table

After that measure the blood pressure.  Blood pressure should be measure in both arms after 1 minute and twice. If right and left arm have different value we take that reading where the blood pressure is more. One arm which is producing high blood pressure values that arm will be used afterward in measuring blood pressure.

If in the both arms the difference is > 20 mmHg then the patient is suspect to peripheral vascular disease. Further investigation should be carried out.  Take at least two measures average of two measures taken as blood pressure.

Size of sphygmomanometer cuffs in measuring blood pressure

In sphygmomanometer cuff should be of proper size. If the arm is > 32 cm large size cuff is used.

What is KROTKOFF sound?

The sound which is heard in the stethoscope by the help of sphygmomanometer is known as “KROTKOFF" sound. 1^st sound is Systolic blood pressure and 5^th or ending sound is last sound which is diastolic blood pressure.

For diagnosing or establishing the blood pressure the elevated blood pressure must be sustained for at least  2 visits / check-ups . The gap between this 2 check-ups range from 1 week – 4 weeks.

If blood pressure is equal or greater than 160/100 . Then this is hypertensive patient the one reading is sufficient to diagnose hypertension.  And when someone can’t come then 1 visit in enough.

Hypertension is associated with other risk factors.

What is white coat hypertension?

White coat hypertension:

When patient have high blood pressure in clinic or office this is known as white coat hypertension . 10-30% patient suffer from white coat hypertension.  These patients are at intermediate risk to cardiovascular diseases.

How we diagnose white coat hypertension?

For white coat hypertension it is necessary to do home blood pressure monitoring or to do ambulatory blood pressure monitoring.

What is ambulatory blood pressure monitoring?

measuring of blood pressure out side the office for 24 hours is called ambulatory blood pressure monitoring. Device place in pocket or somewhere and check blood pressure at regular intervals and store records.

What is mask hypertension?

Mask hypertension:

The patient when come to doctor the blood pressure become low but they are hypertensive patients they are called mask hypertensive patients.  They are at equal risk of cardiovascular disease like true hypertensive patients.

Mask hypertension conformed by the home blood pressure monitoring and ambulatory blood pressure monitoring.

Hypertension rarely present isolated but mostly with other diseases. So not only monitor blood pressure do other test , do complete evaluation of patient.

1^st to take

Personal history of patient for hypertension diagnosis:

First of all ask patient that you know About you have hypertension or not. Taking any hypertensive  medication or not.

Did you have another issue like

• coronary disease
• stroke volume
• heart failure
• transient ischemic attach
• chronic kidney disease
• diabetes mellitus
• smoker
• alcohol consumption
• Physical inactivity
• Family premature hypertension history

Because therapy may change due to these diseases and also change goal blood pressure and effecting the management of hypertension .

Goal blood pressure in hypertension

Goal blood pressure for hypertensive patients is 140/90.

Goal blood pressure of hypertensive patients with other diseases is < 130/80.

Physical examination for hypertension diagnosis:

Measuring blood pressure

Weight and height for BMI examination

Because it going to effect pharma cotherapy.

Waist circumference for hypertension diagnosis:

Waist circumference is risk factor for cardiovascular diseases because cardiovascular diseases risk is linearly proportional to obesity

Male = > 102 cm

Female = > 88 cm

Neurological examination for hypertension diagnosis:

Rule out the cerebrovascular incidence (stroke).

Observe FAST

What is FAST test ?

F = face dropping / numbness of one side of face

A = Arm weakness

S = speech difficulty

T = time , call ambulance as soon as possible

If these conditions exist this suggests the patient is suspect of stroke (ischemic attack).

Personal medication history for hypertension diagnosis:

Take the personal medication history of patient because

• Chronic use of paracetamol increases the risk of hypertension by 1.34%.
• Female taking oral contraceptives increase the risk of getting hypertension.
• If patient taking duloxetin increases the risk of hypertension.
• NSAIDS and tricyclic antidepressants also increase the risk of hypertension.

Also ask about herbal medications. After personal medication history do

Selective lab investigations for hypertension diagnosis:

Serum electrolytes test / renal function test:

You should focus on K+. Normal value of potassium ion is 3.6-5.2 mmol/L which vary from lab to lab.

If potassium ion value is increased along with serum creatinine and blood urea nitrogen this suggest that patient is suffering from chronic kidney disease.

If serum potassium ion is decreased and blood pressure is increased then patient is suffering from Hyperaldosteronism.

Fasting blood glucose test (FBG):

Fasting blood glucose test tell about patient is suspect of diabetes mellitus or not.

Normal value is less than 100 mg / dl . If value is 100-126 then the patient is prediabetic . If value is more than 126 then patient is diabetic patient.

HbA1C test :

This is haemoglobin blood test.

This test is use for monitoring the control on diabetes nit for diagnosis.

Lipid profile for hypertension:

We want that LDL-C should be less than 100 mg /dl and triglycerides less than 200 mg/dl.

If more than this then patient is suffering from hyperlipidemia.

Renal function test for hypertension (RFTs):

Screening:

BUN = blood , urea, nitrogen

Serum electrolytes normal values

Female = 1.1 mg/dl

Male = 1.3 mg/dl

On the basis of creatinine level we calculate estimate glomerular filtration rate (eGFR).

After serum creatinine we calculate eGFR on the basis of which we can tell patient is suffering from chronic kidney disease or not or which stage.

MDRD formula / modified Di renal disease formula

If eGFR is less than 60 ml/min / 1.73m then patient suffering from CKD. Higher than 60 is normal.

Chronic kidney disease epidemiology

Stages of chronic kidney disease (CKD):

Stage 3 a of CKD = 59 – 45 ml/min

Stage 3 b of CKD = 44 – 30 ml/min

Stage 4 of CKD = 29 – 15 ml/min

Stage 5 of CKD = less than 15 and it is renal failure need haemodialysis.

ECG / ECHO for hypertension:

To check any cardiovascular diseases and to check history of myocardial infarction.

After doing all that we know patient is suffering from hypertension either in isolation or with other diseases.

For types of hypertension click here 

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Searching Tags

Diagnosis of hypertension

How hypertension is diagnosed?

How we diagnosed the hypertension?

Why automated electronic devices is preferred toward conventional sphygmomanometer?

How we measure the blood pressure in hypertension?

How we measure the blood pressure of hypertensive patients?

What is the Size of sphygmomanometer cuffs in measuring blood pressure?

What is KROTKOFF sound?

What is white coat hypertension?

How we diagnose white coat hypertension?

What is ambulatory blood pressure monitoring?

What is mask hypertension?

Personal history of patient for hypertension diagnosis

What is the Goal blood pressure in hypertension?

Physical examination for hypertension diagnosis

Waist circumference for hypertension diagnosis

Neurological examination for hypertension diagnosis

What is fast test?

Personal medication history for hypertension diagnosis

Selective lab investigations for hypertension diagnosis

Serum electrolytes test for hypertension

renal function test for hypertension

Fasting blood glucose test (FBG) for hypertension

HbA1C test for hypertension

Lipid profile for hypertension

Renal function test for hypertension (RFTs)

What is MDRD formula ?

What is modified Di renal disease formula?

Chronic kidney disease epidemiology

Stages of chronic kidney disease (CKD):

Stage 3a of chronic kidney disease

Stage 3b of chronic kidney disease

Stage 4 of chronic kidney disease

Stage 5 of chronic kidney disease

Kidney failure stage

Normal value of eGFR

Values of eGFR in chronic kidney disease

ECG / ECHO for hypertension