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Saturday, 2 May 2015

Things not to be missed while managing a patient with recently diagnosed hypertension

Systemic arterial hypertension, defined as sustained elevation in blood pressure above 140/90 , is an extremely common health problem.
Once the diagnosis is made , the main concentration is usually focused on what's the optimum pharmacological therapy.
Besides medications which should be prescribed according to the latest recommendations, taking in consideration individual factors that may favour one drug over the other according to the presence of comorbidities, it's also important not to miss the following:

-History of medications that can cause blood pressure elevation like sympathimimetics or steroids
-Physical signs suggestive of secondary hypertension : for example Cushing's syndrome, radio femoral delay, features of acromegaly, or renal artery bruit
-ECG and echocardiography: looking for left ventricular hypertrophy which suggests longstanding hypertension 
-Renal artery Doppler study : looking for renal artery stenosis
-BUN and creatinine, urine albumin, RBC cast : looking for evidence of renal disease as a cause or a complication of hypertension 
-Examination of the retina : looking for signs of hypertensive retinopathy 
-Serum potassium  : looking for the rare Conn's syndrome (in this case, hypertension is typically mild)
-Screen for hyperlipidemia, diabetes mellitus, and advice quitting smoking

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