Paul’s blood pressure is elevated at the appointment with the practice nurse. As a result, the practice nurse will arrange the following tests:
Dipstick testing of urine for proteinuria
The presence of protein in urine identifies patients with kidney damage, but does not distinguish between patients who have renal disease and secondary hypertension and those in whom kidney damage is due to essential hypertension. (Ref: NICE Clinical Guideline 73)
Blood tests – U&Es, cholesterol and glucose levels
U&E’s are measured to assess kidney function and to exclude renal disease as a cause or consequence of Hypertension. Sodium and potassium levels are checked to exclude hypertension resulting from adrenal disease. Glucose and cholesterol profiles are used to assess cardiovascular risk. (Ref. NICE guidelines 17, 87)
12 lead electrocardiogram (ECG)
An ECG can reveal a person’s heart rate, heart rhythm and highlight any conduction abnormalities. It can show left ventricular size and any highlight damage to specific areas of the heart muscle. In hypertension the presence of left ventricualr hypertrophy (LVH) can be an indicator of target organ damage. If the ECG is suggestive of LVH, an echocardiogram must be performed to either confirm or refute the presence of LVH suggested by the ECG. In some people, particularly slim or athletic individuals, the ECG may suggest LVH but on echocardiogram the left ventricle size will be normal. However, If LVH is present on the echocardiogram then the person must be treated life-long for hypertension, irrespective of their cardiocavular risk calculator score.
Fundoscopy
This is an examination of the eye to detect hypertensive retinopathy, which is a result of untreated hypertension. Most people with hypertensive retinopathy do not have symptoms until late in the disease. Symptoms may include: double vision; dim vision; loss of vision; or headaches. The only treatment for hypertensive retinopathy is good blood pressure control.
Page last reviewed: 17 Sep 2020
