The initial evaluation for a patient with hypertension will be tailored to the individual situation. Blood tests, urine tests and an EKG are fairly standard for most patients that are diagnosed with hypertension. A chest x-ray may be indicated for certain conditions. In some cases an ultrasound of the kidney may be warranted. Other specialized tests will be ordered if there are concerns that secondary hypertension might be present.
There are several blood tests that are important in the initial evaluation of hypertension. These can be drawn together at the same time. A metabolic panel is usually ordered. This will give information regarding the kidney function. Over time hypertension can cause damage to the kidneys. When a patient is first diagnosed with hypertension it is important to determine that the kidneys are still healthy. The metabolic panel will also give information about the liver function. Electrolytes are also checked which can point to metabolic and endocrine disorders. Glucose is also included in the metabolic panel, this can give clues regarding the possibility of underlying diabetes. Blood tests to check the thyroid is also usually checked in this initial evaluation as is a complete blood count. Hemoglobin A1C is a test for diabetes and may be ordered if the patient has risk factors for diabetes such as obesity or strong family history of diabetes.
A urinalysis is also checked in the initial evaluation if Hypertension. The urinalysis can give valuable information on the state of the kidney. An EKG is important as well. The EKG will give information about the heart. It will check for arrhythmias, previous damage to the heart, and other stressors on the heart.
A chest x-ray may or may not be ordered. If there are concerns for heart failure or lung disease a chest x-ray can be very helpful. If the patient is a smoker or has swelling of the legs a chest x-ray can be very helpful. Rarely an ultrasound of the kidney may be needed if there is suspicion of kidney disease.
Secondary hypertension only accounts for 5%-10% of hypertension. A large work up for some of these rare causes of secondary hypertension is usually not indicated. There are times when when an evaluation for secondary hypertension is needed. A thorough history and physical can usually guide the doctor to which of these problems might be present and help determine which tests are needed for some of the more rare causes of hypertension.