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Diagnosing hypertension (high blood pressure) involves measuring blood pressure and assessing overall cardiovascular health. Since hypertension often has no symptoms, regular screening is essential, especially for individuals with risk factors. Here’s a detailed guide to the diagnosis of hypertension:

1. Blood Pressure Measurement

Blood pressure is measured using a sphygmomanometer (blood pressure cuff) and is recorded as two numbers:

• Systolic Pressure: The pressure when the heart beats (top number).
• Diastolic Pressure: The pressure when the heart rests between beats (bottom number).

Blood Pressure Categories

2. Steps for Accurate Diagnosis

A. Initial Screening

• Blood pressure is measured during routine medical visits.
• If elevated, multiple readings are taken over time to confirm hypertension.

B. Confirming Hypertension

• Office-Based Measurements:
  • At least two elevated readings on two or more separate visits.
• Ambulatory Blood Pressure Monitoring (ABPM):
  • A 24-hour blood pressure monitor is worn to track readings throughout the day and night.
  • Helps rule out white coat hypertension(high readings only in a medical setting) or masked hypertension (normal readings in the office but high readings elsewhere).
• Home Blood Pressure Monitoring:
  • Patients measure their blood pressure at home using a validated device.
  • Provides a more accurate picture of blood pressure in a natural setting.

3. Additional Tests

To assess the impact of hypertension and identify underlying causes, your doctor may order:

• Blood Tests:
  • Cholesterol levels, blood sugar, kidney function (creatinine, BUN), and electrolytes.
• Urine Tests:
  • Check for protein or blood in the urine, which may indicate kidney damage.
• Electrocardiogram (ECG or EKG):
  • Evaluates heart rhythm and detects signs of heart damage.
• Echocardiogram:
  • Assesses heart structure and function.
• Eye Exam:
  • Checks for hypertensive retinopathy(damage to blood vessels in the eyes).
• Ultrasound of the Kidneys:
  • Evaluates kidney size and structure.

4. Identifying Secondary Hypertension

If hypertension is severe, resistant to treatment, or occurs in a young person, your doctor may investigate secondary causes, such as:

• Kidney Disease: Blood and urine tests, kidney ultrasound.
• Hormonal Disorders:
  • Primary Aldosteronism: High aldosterone levels.
  • Cushing’s Syndrome: High cortisol levels.
  • Pheochromocytoma: High catecholamine levels.
• Sleep Apnea: Sleep study to assess breathing during sleep.
• Medications: Review of medications that may raise blood pressure (e.g., NSAIDs, decongestants).

5. Assessing Cardiovascular Risk

Your doctor will evaluate your overall risk for heart disease and stroke using factors such as:

• Age, sex, and family history.
• Smoking status.
• Cholesterol levels.
• Diabetes or prediabetes.
• Obesity or overweight.
• Physical inactivity.

6. When to Diagnose Hypertension

• Elevated Blood Pressure: 120-129/<80 mmHg (lifestyle changes recommended).
• Hypertension Stage 1: 130-139/80-89 mmHg (lifestyle changes and possibly medications).
• Hypertension Stage 2: ≥140/90 mmHg (lifestyle changes and medications).

7. Special Considerations

• White Coat Hypertension:
  • High blood pressure readings in a medical setting but normal readings at home.
  • Diagnosed using ABPM or home monitoring.
• Masked Hypertension:
  • Normal blood pressure readings in a medical setting but high readings at home.
  • Diagnosed using ABPM or home monitoring.
• Resistant Hypertension:
  • Blood pressure remains high despite taking three or more antihypertensive medications.
  • Requires further investigation for secondary causes.

8. Follow-Up and Monitoring

• Regular blood pressure checks are essential for managing hypertension.
• Patients with hypertension should monitor their blood pressure at home and keep a log for their doctor.

Key Points

• Hypertension is diagnosed based on multiple elevated blood pressure readings.
• Additional tests may be needed to assess the impact of high blood pressure and identify underlying causes.
• Early diagnosis and treatment are crucial to prevent complications like heart disease, stroke, and kidney damage.

If you have elevated blood pressure or risk factors for hypertension, consult your healthcare provider for proper evaluation and management. Regular monitoring and lifestyle changes can help keep your blood pressure under control.