High Blood Pressure (Hypertension)

What Happens if Your Blood Pressure is High?

If your blood pressure readings suggest that you have high blood pressure, your doctor will conduct a thorough evaluation of your health status. In order to determine the best course of treatment for you, your doctor will look for answers to the following questions:

  • Is there an identifiable cause of the hypertension?
  • Are other risk factors for heart disease present?
  • Is there evidence of damage to other organs? If so, what is its extent?
  • Is there another condition that may influence the outcome or treatment?

Need to Know:

Although in most people no cause is found for the high blood pressure, the doctor must first rule out a possible cause. That’s because identification and correction of a condition that may be causing the high blood pressure often leads to normal readings.

To evaluate your health status, your doctor will use these tools:

  • Personal health history
  • A physical examination
  • Routine tests your doctor may request
  • Other tests your doctor may request

Personal Health History

A personal health history is one of the most important tools doctors use to determine the most appropriate treatment for you. Your doctor will ask a series of questions including:

  • Does anyone in your family have a history of:
    • High blood pressure
    • Coronary heart disease
    • Diabetes
    • Stroke
    • High cholesterol levels
    • Kidney disease
  • Do you have any personal habits that could affect your blood pressure, such as smoking, illicit drug use, or a sedentary lifestyle?
  • What dietary factors could be affecting your blood pressure? These include sodium (e.g., table salt), saturated fats, alcohol, and caffeine (e.g., coffee, colas).
  • What prescription, over-the-counter medications (such as decongestants), and/or herbal remedies are you taking?
  • Have you ever been treated for high blood pressure before? What were the results and, and were there any adverse effects?
  • Do you have a history of heart disease?
  • What recent changes in weight, physical activity, leisure-time activities, or other psychosocial and environmental factors (such as family situation or occupation) might be influencing your blood pressure?

Physical Examination

The physical examination can also help your doctor to determine the right treatment for you, and can help to rule out specific causes of hypertension that can be corrected. In addition to obtaining additional blood pressure readings, the doctor will look for possible involvement of other organs.

During the physical examination, the doctor will look for:

  • Health indicators including blood pressure, heart rate, respiratory rate, body temperature, height, weight, and girth. Blood pressure readings may be obtained in both arms and in different positions (such as while lying down and standing).
  • Evidence of damage to blood vessels in the eyes
  • Abnormal sounds in blood vessels in neck that may occur with coronary artery disease, called carotid bruits
  • Distended neck veins, which are sometimes seen with heart failure
  • An enlarged thyroid gland, which may suggest an underlying thyroid condition
  • Abnormalities in heart rate, rhythm, or size
  • Abnormal heart sounds
  • Abnormal crackling or wheezing sounds in the lungs, which may suggest heart failure
  • Masses in the abdomen, called bruits
  • Abnormal pulsations of the aorta
  • Abnormal kidney size, which may suggest kidney disease
  • Decreased or absent pulses in the extremities, which may indicate peripheral vascular disease
  • Swelling in the lower leg due to accumulation of watery fluid in tissues, which may indicate heart failure or other conditions
  • Changes in mental function, sensation, motor control, or reflexes

Routine Tests Your Doctor May Request

Your doctor will use information obtained from your personal health history and physical examination to determine which laboratory tests and imaging studies you should undergo. The following tests are routine:

  • Urinalysis, or analysis of the urine
  • Complete blood cell count, which determines the number of each major type of blood cell; involves drawing blood
  • A 12-lead electrocardiogram (ECG or EKG) that provides a record of the heart’s electrical activity
  • Blood chemistry tests including:
    • Potassium level
    • Sodium level
    • Creatinine level, which is a way to measure kidney function
    • Fasting glucose level (level of blood sugar in fasting state)
    • Total cholesterol level and triglyceride level
    • High-density lipoprotein (HDL) cholesterol level analysis. This is sometimes called “good cholesterol.”
    • Low-density lipoprotein (LDL) cholesterol level analysis. This is sometimes called “bad cholesterol”.

Other Tests Your Doctor May Request

Hypertension due to a known cause is not very common. But if information from your personal health history and physical examination suggest that there may be an underlying cause for your high blood pressure, your doctor may order additional tests. Other tests also may used to determine or confirm the presence of other risk factors for heart disease and damage to other organs.

Other tests your doctor may want you to have include:

  • Creatinine clearance, a urine test to screen for kidney disease
  • Fasting triglyceride level and low-density lipoprotein (LDL) cholesterol level
  • Blood calcium level to screen for hyperparathyroidism
  • Blood uric acid level to screen for gout
  • Glycosylated hemoglobin to screen for diabetes mellitus
  • Thyroid-stimulating hormone to screen for thyroid disease
  • Chest x-ray to screen for signs of coarctation of the aorta
  • Echocardiography to screen for evidence of heart failure
  • Ultrasonography of arteries or measurement of ankle/arm index to screen for peripheral vascular disease

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