Hypertension

Question 1

Examination after new-diagnosis hypertension

Answer 1

• Pulse rate, rhythm, character
• Jugular venous pulse and pressure
• Evidence of cardiac enlargement (displaced apex beat, extra heart sounds)
• Evidence of cardiac failure (basal crackles on lung auscultation, peripheral oedema, pulsatile liver)
• Evidence of arterial disease (Bruits, AAA pulsation, absent femoral pulses, radio-femoral delay)
• Palpation of enlarged kidneys (Polycystic kidneys)
• Abnormalities of optic fundi (retinal haemorrhages, papilloedema, AV nipping, exudates of diabetic retinopathy),
• Evidence of endocrine abnormalities (Cushings, Hyperthyroidism, Conns, Phaeochromocytoma)
• Waist circumference
• ## BMI

Question 2

Investigations with new-diagnosis hypertension

Answer 2

• Urine dipstick for haematuria
• Urine ACR
• Fasting BSL
• Fasting Lipids
• EUC
• FBC
• ECG (looking for AF, LVH and evidence of previous IHD)

Note: no routine investigation of secondary causes. Use targeted approach

Cases to consider further investigation
- New onset at very young or old age.
- Abrupt onset of HTN with previously well-controlled BP.
- Drug-resistant HTN
- Presence of clinical cue for specific cause of HTN (abdominal bruit (?renovascular HTN), low serum K (Primary aldosteronism)