Advertisement
Mayo Clinic Proceedings Home

Initial Assessment of the Patient With Hypertension

      The initial assessment of a patient with hypertension can easily be done in a primary-care setting. The goals of the examination are to determine whether the patient is truly hypertensive and, if so, the severity of the hypertension, the degree of target-organ involvement, the presence of curable causes of hypertension, the patient's overall cardiovascular risk profile, and the patient's understanding and willingness to adopt necessary life-style changes and comply with treatment.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Kannel WB
        Some lesions in cardiovascular epidemiology from Framingham.
        Am J Cardiol. 1976; 37: 269-282
        • Griner PF
        • Mayewski RJ
        • Mushlin AI
        • Greenland P
        Selection and interpretation of diagnostic tests and procedures: principles and applications.
        Ann Intern Med. 1981; 94: 553-592
        • Mancia G
        • Bertinieri G
        • Grassi G
        • Parati G
        • Pomidossi G
        • Ferrari A
        • Gregorini L
        • Zanchetti A
        Effects of blood-pressure measurements by the doctor on patient's blood pressure and heart rate.
        Lancet. 1983; 2: 695-698
      1. The 1984 Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure.
        Arch Intern Med. 1984; 144: 1045-1057
        • Kirkendall WM
        • Feinleib M
        • Freis ED
        • Mark AL
        Recommendations for human blood pressure determination by sphygmomanometers: Subcommittee of the AHA Postgraduate Education Committee.
        Circulation. 1980; 62: 1146A-1155A
        • Strong CG
        Initial evaluation of the patient with hypertension.
        in: Hunt JC Dreifus LS Dustan HP Frohlich ED Gifford Jr, RW Kaplan NM Maxwell MM Hypertension Update II. Vol 1. Health Learning Systems, Lyndhurst, New Jersey1984: 1-11
        • Pessina AC
        • Palatini P
        • Sperti G
        • Cordone L
        • Libardoni M
        • Mos L
        • Mormino P
        • Di Marco A
        • Dal Palù C
        Evaluation of hypertension and related target organ damage by average day-time blood pressure.
        Clin Exp Hypertens [A]. 1985; 7: 267-278
        • Pickering TG
        • Harshfield GA
        • Laragh JH
        Ambulatory versus casual blood pressure in the diagnosis of hypertensive patients.
        Clin Exp Hypertens [A]. 1985; 7: 257-266
        • White WB
        Assessment of patients with office hypertension by 24-hour noninvasive ambulatory blood pressure monitoring.
        Arch Intern Med. 1986; 146: 2196-2199
        • Dal Palù C
        • Pessina AC
        • Rossi GP
        The diagnostic approach to the hypertensive patient.
        Contrib Nephrol. 1987; 54: 32-37
        • Perloff D
        • Sokolow M
        • Cowan R
        The prognostic value of ambulatory blood pressures.
        JAMA. 1983; 249: 2792-2798
        • Veterans Administration Cooperative Study Group on Antihypertensive Agents
        Effects of treatment on morbidity in hypertension: results in patients with diastolic blood pressures averaging 115 through 129 mm Hg.
        JAMA. 1967; 202: 1028-1034
        • Veterans Administration Cooperative Study Group on Antihypertensive Agents
        Effects of treatment on morbidity in hypertension. II. Results in patients with diastolic blood pressure averaging 90 through 114 mm Hg.
        JAMA. 1970; 213: 1143-1152
        • Smith WM
        Treatment of mild hypertension: results of a ten-year intervention trial.
        Circ Res. 1977; 40: I98-I105
        • Hypertension Detection and Follow-Up Program Cooperative Group
        Five-year findings of the Hypertension Detection and Follow-Up Program. I. Reduction in mortality of persons with high blood pressure, including mild hypertension.
        JAMA. 1979; 242: 2562-2571
        • Hypertension Detection and Follow-Up Program Cooperative Group
        Five-year findings in Hypertension Detection and Follow-Up Program. II. Mortality by race-sex and age.
        JAMA. 1979; 242: 2572-2577
        • Hypertension Detection and Follow-Up Program Cooperative Group
        The effect of treatment on mortality in “mild” hypertension: results of the Hypertension Detection and Follow-Up Program.
        N Engl J Med. 1982; 307: 976-980
        • Multiple Risk Factor Intervention Trial Research Group
        Multiple Risk Factor Intervention Trial: risk factor changes and mortality results.
        JAMA. 1982; 248: 1465-1477
        • Helgeland A
        Treatment of mild hypertension: a five year controlled drug trial; the Oslo study.
        Am J Med. 1980; 69: 725-732
        • Leren P
        • Helgeland A
        Coronary heart disease and treatment of hypertension: some Oslo study data.
        Am J Med. 1986; 80: 3-6
        • Medical Research Council Working Party
        MRC trial of treatment of mild hypertension: principal results.
        Br Med J. 1985; 291: 97-104
      2. Adverse reactions to bendrofluazide and propranolol for the treatment of mild hypertension: report of the Medical Research Council Working Party on Mild to Moderate Hypertension.
        Lancet. 1981; 2: 539-543
        • Berglund G
        • Andersson O
        Beta-blockers or diuretics in hypertension? A six year follow-up of blood pressure and metabolic side effects.
        Lancet. 1981; 1: 744-747
      3. The Australian therapeutic trial in mild hypertension: report by the management committee.
        Lancet. 1980; 1: 1261-1267
      4. Untreated mild hypertension: a report by the management committee of the Australian therapeutic trial in mild hypertension.
        Lancet. 1982; 1: 185-191
        • The Management Committee of the Australian National Blood Pressure Study
        Prognostic factors in the treatment of mild hypertension.
        Circulation. 1984; 69: 668-676
        • Campese VM
        Management of essential hypertension: whom, when and how to treat.
        Contrib Nephrol. 1987; 54: 38-53
        • Stamler J
        • Stamler R
        Intervention for the prevention and control of hypertension and atherosclerotic diseases: United States and international experience.
        Am J Med. 1984; 76: 13-36
      5. Guidelines for the treatment of mild hypertension: memorandum from a WHO/ISH meeting.
        Hypertension. 1983; 5: 394-397
        • Keith NM
        • Wagener HP
        • Barker NW
        Some different types of essential hypertension: their course and prognosis.
        Am J Med Sci. 1939; 197: 332-343
        • Kirkendall WM
        • Armstrong ML
        Vascular changes in the eye of the treated and untreated patient with essential hypertension.
        Am J Cardiol. 1962; 9: 663-668
        • Breslin DJ
        • Gifford Jr, RW
        • Fairbairn II, JF
        • Kearns TP
        Prognostic importance of ophthalmoscopic findings in essential hypertension.
        JAMA. 1966; 195: 335-338
        • Barlow J
        • Kincaid-Smith P
        The auscultatory findings in hypertension.
        Br Heart J. 1960; 22: 505-514
        • Buckels JAC
        • Webb AMC
        • Rhodes A
        Is paroxysmal thyroid swelling due to phaeochromocytoma a forgotten physical sign?.
        Br Med J. 1983; 287: 1206-1207
        • Tracy RE
        • Overll EO
        Arterioles of perfusion-fixed hypertensive and aged kidneys.
        Arch Pathol. 1966; 82: 526-534
        • Reubi FC
        • Weidmann P
        • Hodler J
        • Cottier PT
        Changes in renal function in essential hypertension.
        Am J Med. 1978; 64: 556-563
        • Sommers SC
        • Relman AS
        • Smithwick RH
        Histologic studies of kidney biopsy specimens from patients with hypertension.
        Am J Pathol. 1958; 34: 685-715
        • Saltz M
        • Sommers SC
        • Smithwick RH
        Clinicopathologic correlations of renal biopsies from essential hypertensive patients.
        Circulation. 1957; 16: 207-212
        • Ladefoged J
        • Pedersen F
        Renal blood flow in patients with hypertension.
        Clin Sci. 1969; 37: 253-262
        • Lowenstein J
        • Steinmetz PR
        • Effros RM
        • Demeester M
        • Chasis H
        • Baldwin DS
        • Gromez DM
        The distribution of intrarenal blood flow in normal and hypertensive man.
        Circulation. 1967; 35: 250-259
        • Gruenewald SM
        • Nimmon CC
        • Nawaz MK
        • Britton KE
        A non-invasive γ-camera technique for the measurement of intrarenal flow distribution in man.
        Clin Sci. 1981; 61: 385-389
        • Hollenberg NK
        • Merrill JP
        Intrarenal perfusion in the young “essential” hypertensive: a subpopulation resistant to sodium restriction.
        Trans Assoc Am Physicians. 1970; 83: 93-100
        • Britton KE
        Essential hypertension: a disorder of cortical nephron control?.
        Lancet. 1981; 2: 900-902
        • Messerli FH
        • Nunez BD
        • Schmieder RE
        Early detection of target organ disease in essential hypertension.
        Contrib Nephrol. 1987; 54: 21-31
        • Brenner BM
        • Meyer TW
        • Hostetter TH
        Dietary protein intake and the progressive nature of kidney disease: the role of hemodynamically mediated glomerular injury in the pathogenesis of progressive glomerular sclerosis in aging, renal ablation, and intrinsic renal disease.
        N Engl J Med. 1982; 307: 652-659
        • Meyer TW
        • Anderson S
        • Brenner B
        Dietary protein intake and progressive glomerular sclerosis: the role of capillary hypertension and hyperperfusion in the progression of renal disease.
        Ann Intern Med. 1983; 98: 832-838
        • Messerli FH
        • Frohlich ED
        • Dreslinski GR
        • Suarez DH
        • Aristimuno GG
        Serum uric acid in essential hypertension: an indicator of renal vascular involvement.
        Ann Intern Med. 1980; 93: 817-821
        • Baldwin DS
        • Biggs AW
        • Goldring W
        • Hulet WH
        • Chasis H
        Exaggerated natriuresis in essential hypertension.
        Am J Med. 1958; 24: 893-902
        • Julius S
        • Randall OS
        • Esler MD
        • Kashima T
        • Ellic C
        • Bennett J
        Altered cardiac responsiveness and regulation in the normal cardiac output type of borderline hypertension.
        Circ Res. 1975; 36: I199-I207
        • Mehta SK
        • Bahler RC
        • Hanson R
        • Walsh JT
        • Rakita L
        Relative tachycardia in ambulant children with borderline hypertension.
        Am Heart J. 1986; 112: 1257-1263
        • Julius S
        • Pascual AV
        • Sannarstedt R
        • Mitchell C
        Relationship between cardiac output and peripheral resistance in borderline hypertension.
        Circulation. 1971; 43: 382-390
        • Julius S
        • Pascual AV
        • London R
        Role of parasympathetic inhibition in the hyperkinetic type of borderline hypertension.
        Circulation. 1971; 44: 413-418
        • Julius S
        • Esler M
        Autonomic nervous cardiovascular regulation in borderline hypertension.
        Am J Cardiol. 1975; 36: 685-696
        • Frohlich ED
        • Tarazi RC
        • Dustan HP
        Hyperdynamic β-adrenergic circulatory state: increased β-receptor responsiveness.
        Arch Intern Med. 1969; 123: 1-7
        • Wikstrand J
        Left ventricular function in early primary hypertension: functional consequences of cardiovascular structural changes.
        Hypertension. 1984; 6: III108-III116
        • Devereux RB
        • Savage DD
        • Sachs I
        • Laragh JH
        Relation of hemodynamic load to left ventricular hypertrophy and performance in hypertension.
        Am J Cardiol. 1983; 51: 171-176
        • Safar ME
        • Lehner JP
        • Vincent MI
        • Plainfosse MT
        • Simon AC
        Echocardiographic dimensions in borderline and sustained hypertension.
        Am J Cardiol. 1979; 44: 930-935
        • Kansal S
        • Roitman D
        • Sheffield T
        Interventricular septal thickness and left ventricular hypertrophy: an echocardiographic study.
        Circulation. 1979; 60: 1058-1065
        • Dreslinski GR
        • Frohlich ED
        • Dunn FG
        • Messerli FH
        • Suarez DH
        • Reisin E
        Echocardiographic diastolic ventricular abnormality in hypertensive heart disease: atrial emptying index.
        Am J Cardiol. 1981; 47: 1087-1090
        • Savage DD
        • Drayer JIM
        • Henry WL
        • Mathews EC
        • Ware JH
        • Gardin JM
        • Cohen ER
        • Epstein SE
        • Laragh JH
        Echocardiographic assessment of cardiac anatomy and function in hypertensive subjects.
        Circulation. 1979; 59: 623-632
        • Kannel WB
        • Gordon T
        • Offutt D
        Left ventricular hypertrophy by electrocardiogram: prevalence, incidence, and mortality in the Framingham study.
        Ann Intern Med. 1969; 71: 89-105
        • Messerli FH
        • Ventura HO
        • Snyder DW
        Eccentric left ventricular hypertrophy—a determinant of increased ventricular ectopy in obesity (abstract).
        J Am Coll Cardiol. 1986; 7: 187A
        • Messerli FH
        • Ventura HO
        • Elizardi DJ
        • Dunn FG
        • Frohlich ED
        Hypertension and sudden death: increased ventricular ectopic activity in left ventricular hypertrophy.
        Am J Med. 1984; 77: 18-22
        • Reichek N
        • Devereux RB
        Left ventricular hypertrophy: relationship of anatomic, echocardiographic and electrocardiographic findings.
        Circulation. 1981; 63: 1391-1398
        • Glover L
        • Baxley WA
        • Dodge HT
        A quantitative evaluation of heart size measurements from chest roentgenograms.
        Circulation. 1973; 47: 1289-1296
        • Ditchey RV
        • Schuler G
        • Peterson KL
        Reliability of echocardiographic and electrocardiographic parameters in assessing serial changes in left ventricular mass.
        Am J Med. 1981; 70: 1042-1050
        • Woythaler JN
        • Singer SL
        • Kwan OL
        • Meltzer RS
        • Reubner B
        • Bommer W
        • DeMaria A
        Accuracy of echocardiography versus electrocardiography in detecting left ventricular hypertrophy: comparison with postmortem mass measurements.
        J Am Coll Cardiol. 1983; 2: 305-311
        • Sandok BA
        • Whisnant JP
        Hypertension and the brain.
        Arch Intern Med. 1974; 133: 947-954
        • Strandgaard S
        • Olesen J
        • Skinhøj E
        • Lassen NA
        Autoregulation of brain circulation in severe arterial hypertension.
        Br Med J. 1973; 1: 507-510
        • Harper AM
        Autoregulation of cerebral blood flow: influence of the arterial blood pressure on the blood flow through the cerebral cortex.
        J Neurol Neurosurg Psychiatry. 1966; 29: 398-403
        • Heath III, H
        • Hodgson SF
        • Kennedy MA
        Primary hyperparathyroidism: incidence, morbidity, and potential economic impact in a community.
        N Engl J Med. 1980; 302: 189-193
      6. The 1980 Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure.
        Arch Intern Med. 1980; 140: 1280-1285
        • Sackett DL
        The hypertensive patient. 3. Clinical work-up (editorial).
        Can Med Assoc J. 1979; 121 (11): 7-8