Advertisement
Research Article| Volume 13, ISSUE 1, P287-302, March 1993

Evaluation of Elevated Blood Pressure

  • Raymond R. Townsend
    Correspondence
    Address reprint requests to: Raymond R. Townsend, MD, Department of Internal Medicine, University of Texas Medical Branch, OJSH 4.174 E-66, Galveston, TX 77555-0566.
    Affiliations
    From the Division of General Internal Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
    Search for articles by this author
  • Donald J. DiPette
    Affiliations
    From the Division of General Internal Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas
    Search for articles by this author
      This paper is only available as a PDF. To read, Please Download here.
      Hypertension is often primary, or essential, in which no apparent cause can be determined from the usual investigative maneuvers, such as taking a history, performing a physical examination, and screening laboratory results. In these individuals, the laboratory serves chiefly to estimate target organ damage, if present, and to identify the presence of other cardiovascular risk factors that may influence the choice of antihypertensive therapy. In other patients, the screening laboratory findings, in conjunction with the appropriate clinical setting, leads to the choice of specific diagnostic tests that elucidate the presence of a secondary cause for hypertension. This review covers the rationale for the basic screening tests and the pursuit of suspicious findings from the screening laboratory evaluation.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.

      Content published before 2002 is available via pay-per-view purchase only.

      Subscribe:

      Subscribe to Clinics in Laboratory Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Austin M.A.
        Plasma triglyceride as a risk factor for coronary heart disease: the epidemiologic evidence and beyond.
        Am J Epidemiol. 1989; 129: 249-259
        • Biglieri E.G.
        • Herron M.A.
        • Brust N.
        17-Hydroxy la tion deficiency in man.
        J Clin Invest. 1966; 45: L1946-1954
        • Biglieri E.G.
        • Schambelan M.
        The significance of elevated levels of plasma 18-hydroxycortisone in patients with primary aldosteronism.
        J Clin Endocrinol Metab. 1979; 49: 87-91
        • Bravo E.L.
        • Tarazi R.C.
        • Fouad F.M.
        • et al.
        Clonidine-suppression test. A useful aid in the diagnosis of pheochromocytoma.
        N Engl J Med. 1981; 305: 623-626
        • Bravo E.L.
        • Tarazi R.C.
        • Gifford R.W.
        • et al.
        Circulating and urinary catecholamines in pheochromocytoma.
        N Engl J Med. 1979; 301: 682-686
        • Brown M.J.
        Simultaneous assay of noradrenaline and its deaminated metabolite, di-hydroxyphenylglycol, in plasma: a simplified approach to the exclusion of phaeochro-mocytoma in patients with borderline elevation of plasma noradrenaline concentration.
        Eur J Clin Invest. 1984; 14: 67-72
        • Case D.B.
        • Wallace J.M.
        • Keim H.J.
        • et al.
        Possible role of renin in hypertension suggested by renin-sodium profiling and inhibition of converting enzyme.
        N Engl J Med. 1977; 296: 641-646
        • Castelli W.P.
        Epidemiology of coronary heart disease: the Framingham study.
        Am J Med. 1984; 76: 4-12
        • Christy N.P.
        • Laragh J.H.
        Pathogensis of hypokalemia alkalosis in Cushing’s syndrome.
        N Engl J Med. 1961; 265: 1083-1088
        • Cockcroft D.W.
        • Gault M.H.
        Prediction of creatinine clearance from serum creatinine.
        Nephron. 1975; 16: 31-41
        • Conn J.W.
        Primary aldosteronism, a new clinical syndrome.
        J Lab Clin Med. 1955; 45: 3-17
        • Conn J.W.
        • Cohen E.L.
        • Rovner D.R.
        Suppression of plasma renin activity in primary aldosteronism.
        JAMA. 1964; 190: 213-221
        • Crapo L.
        Cushing’s syndrome: a review of diagnostic tests.
        Metabolism. 1979; 28: 955-977
        • Cryer P.E.
        Phaeochromocytoma.
        Clin Endocrinol Metab. 1985; 14: 203-220
        • Curtis J.J.
        • Luke R.G.
        • Welchel J.D.
        • et al.
        Inhibition of angiotensin-converting enzyme in renal transplant recipients with hypertension.
        N Engl J Med. 1983; 308: 377-381
        • Cushing H.W.
        The basophil adenomas of the pituitary body and their clinical manifestations (pituitary basophilism).
        Bull Johns Hopkins Hosp. 1932; 50: 137-195
        • Davis B.A.
        • Crook J.E.
        • Vestal R.E.
        • et al.
        Prevalence of renovascular hypertension in patients with grade III or IV hypertensive retinopathy.
        N Engl J Med. 1979; 301: 1273-1276
        • Dean R.H.
        • Kieffer R.W.
        • Smith B.W.
        • et al.
        Renovascular hypertension. Anatomie and renal functional changes during drug therapy.
        Arch Surg. 1981; 116: 1408-1415
        • Devereux R.B.
        • Case D.B.
        • Alderman M.H.
        • et al.
        Possible role of increased blood viscosity in the hemodynamics of hypertension.
        J Am Coll Cardiol. 1984; 3: 517
        • Duncan M.W.
        • Compton P.
        • Lazarus L.
        • et al.
        Measurement of norepinephrine and 3,4-dihydroxyphenylglycol in urine and plasma for the diagnosis of pheochromocytoma.
        N Engl J Med. 1988; 319: 136-142
        • The Expert Panel
        Report of the National Cholesterol Education Program expert panel on detection, evaluation, and treatment of high blood cholesterol in adults.
        Arch Intern Med. 1988; 148: 36-69
        • Geisböck F.
        Die Bedeutung der Blutdruckmessung fur die Praxis.
        Deutsch Arch Klin Med. 1905; 83: 363-409
        • Gold E.M.
        The Cushing syndromes: changing views of diagnosis and treatment.
        Ann Intern Med. 1979; 90: 829-844
        • Goldenberg K.
        • Snyder D.K.
        Screening for primary aldosteronism. Hypokalemia in hypertensive patients.
        J Gen Intern Med. 1986; 1: 368-372
        • Grant C.S.
        • Carpenter P.
        • van Heerden J.A.
        • et al.
        Primary aldosteronism. Clinical management.
        Arch Surg. 1984; 119: 585-590
        • Grim C.E.
        • Luft F.C.
        • Weinberger M.H.
        • et al.
        Sensitivity and specificity of screening tests for renal vascular hypertension.
        Ann Intern Med. 1979; 91: 617-622
        • Holland O.B.
        • Brown H.
        • Kuhnert L.V.
        • et al.
        Further evaluation of saline infusion for the diagnosis of primary aldosteronism.
        Hypertension. 1984; 6: 717-723
        • Hricik D.E.
        • Browning P.J.
        • Kapelman R.
        • et al.
        Captopril-induced functional renal insufficiency in patients with bilateral renal-artery stenoses or renal-artery stenosis in a solitary kidney.
        N Engl J Med. 1983; 308: 373-376
        • Hughes J.S.
        • Dove H.G.
        • Gifford Jr, R.W.
        • et al.
        Duration of blood pressure elevation in accurately predicting surgical cure of renovascular hypertension.
        Am Heart J. 1981; 101: 408-413
      1. Hypertension Detection and Follow-up Program Cooperative Group.
        Circ Res. 1977; 40: I-106-I-109
        • 1988 Joint National Committee
        The 1988 report of the Joint National Committee on detection, evaluation, and treatment of high blood pressure.
        Arch Intern Med. 1988; 148: 1023-1038
        • Kännel W.B.
        • Gordon R.
        • Wolf P.A.
        • et al.
        Hemoglobin and the risk of cerebral infarction: the Framingham study.
        Stroke. 1972; 3: 409-420
        • Lafferty F.W.
        Primary hyperparathyroidism. Changing clinical spectrum, prevalence of hypertension, and discriminant analysis of laboratory tests.
        Arch Intern Med. 1981; 141: 1761-1766
        • Lyons D.F.
        • Kem D.C.
        • Brown R.D.
        • et al.
        Single dose captopril as a diagnostic test for primary aldosteronism.
        J Clin Endocrinol Metab. 1983; 57: 892-896
        • Manger W.M.
        • Gifford Jr, R.W.
        Pheochromocytoma.
        in: Laragh and Brenner: Hypertension Pathophysiology, Diagnosis and Management. Raven Press, New York1990: 1639-1659
        • McDonough J.R.
        • Harnes C.G.
        • Garrison G.E.
        • et al.
        The relationship of hematocrit to cardiovascular states of health in the negro and white population of Evans county, Georgia.
        J Chronic Dis. 1964; 18: 243-257
      2. Muller FB, Sealey JE, Case DB, et al: The captopril test for identifying renovascular disease in hypertensive patients. 80:633-644, 1986

        • National Diabetes Data Group
        Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance.
        Diabetes. 1979; 28: 1039-1057
        • New M.I.
        • Duopont B.
        • Pang S.
        An update of congenital adrenal hyperplasia.
        Recent Prog Horm Res. 1981; 37: 105-181
        • O’Connor D.T.
        • Deftos L.J.
        Secretion of chromogranin A by peptide-producing endocrine neoplasms.
        N Engl J Med. 1986; 314: 1145-1151
        • Pettinger W.A.
        • Mitchell H.C.
        • Lee H.-C.
        • et al.
        Pseudo renal artery stenosis (PRAS) syndrome.
        Am J Hypertens. 1989; 2: 349-351
        • Pollare T.
        • Lithell H.
        • Berne C.
        A comparison of the effects of hydrochlorothiazide and captopril on glucose and lipid metabolism in patients with hypertension.
        N Engl J Med. 1989; 321: 868-873
        • Salazar D.E.
        • Corcoran G.B.
        Predicting creatinine clearance and renal drug clearance in obese patients from estimated fat-free body mass.
        Am J Med. 1988; 84: 1053-1060
        • Schreiber M.J.
        • Pohl M.A.
        • Novick A.C.
        The natural history of atherosclerotic and fibrous renal artery disease.
        Urol Clin North Am. 1984; 11: 383-392
        • Sheps S.
        • Nai-Siang J.
        • Klee G.G.
        Diagnostic evaluation of pheochromocytoma.
        Endocrinol Metab Clin North Am. 1988; 17: 397-414
        • Subcommittee on Definition and Prevalence of the 1984 Joint National Committee
        Hypertension prevalence and status of awareness, treatment, and control in the United States.
        Hypertension. 1985; 7: 457-468
        • Svetky L.P.
        • Himmelstein S.I.
        • Dunnick R.
        • et al.
        Prospective analysis of strategies for diagnosing renovascular hypertension.
        Hypertension. 1989; 14: 247-257
        • Swislocki A.L.M.
        • Hoffman B.B.
        • Reaven G.M.
        Insulin resistance, glucose intolerance and hyperinsulinemia in patients with hypertension.
        Am J Hypertens. 1989; 2: 419-423
        • Thind G.S.
        Role of renal venous renins in the diagnosis and management of renovascular hypertension.
        J Urol. 1985; 134: 2-5
        • Vaughan Jr, E.D.
        • Buhler F.R.
        • Laragh J.H.
        • et al.
        Renovascular hypertension: renin measurements to indicate hypersecretion and contralateral suppression, estimate renal plasma flow, and score for surgical curability.
        Am J Med. 1973; 55: 402-414
        • Vaughan Jr, E.D.
        • Case D.B.
        • Pickering T.G.
        • et al.
        Clinical evaluation of renovascular hypertension and therapeutic decisions.
        Urol Clin North Am. 1984; 11: 393-407
        • Weinberger M.H.
        Primary aldosteronism: diagnosis and differentiation of subtypes.
        Ann Intern Med. 1984; 100: 300-302
        • Weinberger M.H.
        • Grim C.E.
        • Hollifield J.W.
        • et al.
        Primary aldosteronism. Diagnosis, localization, and treatment.
        Ann Intern Med. 1979; 90: 386-395
        • The Working Group on Hypertension in Diabetes
        Statement on hypertension in diabetes mellitus. Final Report.
        Arch Intern Med. 1987; 147: 830-842