High Blood Pressure (Hypertension)

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Diagnosis

Generally, doctors do not diagnose a patient with high blood pressure based on one set of readings, because there are many factors that can artificially raise a patient's blood pressure. A patient may have rushed to the doctor's office and may still have high adrenaline levels. Seeing a new health care provider for the first time can make a patient nervous and raise blood pressure. "White coat hypertension" is experienced by some patients whose blood pressure is higher when measured by the doctor than when measured by another health care provider.

Measuring Blood Pressure
The most precise way to measure blood pressure is to place a small tube or catheter into an artery and directly measure the pressures. Usually, a much simpler method is employed. The health care provider places a blood pressure cuff around the upper arm and inflates the cuff with air. As the cuff becomes filled with air, the pressure in the cuff increases, eventually cutting off the flow of blood through the arteries in the arm. The health care provider slowly lets air leak out of the blood pressure cuff, causing the pressure in the cuff to gradually decrease. When the pressure in the cuff falls below the systolic blood pressure in the arteries, the provider begins to hear a characteristic thumping sound as blood starts to flow again in the arm. The blood pressure cuff continues to deflate, and when the pressure in the cuff falls below the diastolic blood pressure in the arteries, the characteristic thumping sound disappears. By listening for the beginning and termination of this sound and simultaneously watching the pressure gauge in the cuff when these events occur, the health care provider determines the systolic and diastolic blood pressure.

If the blood pressure is not measured correctly, the readings obtained may be artificially high. Several steps ensure that the measured blood pressure truly represents the patient's blood pressure:

1. Patients should sit with their arms supported at heart level.
2. Patients should not smoke or ingest caffeine for 30 minutes prior to blood pressure measurement.
3. Patients should sit down for at least 5 minutes before blood pressure is measured.
4. The bladder (inflatable part) of the blood pressure cuff should encircle at least 80% of the arm. A large cuff should be used for patients with thick arms.
5. Two or more readings should be taken at least 2 minutes apart.

Evaluation
Evaluation of patients with high blood pressure consists primarily of the following:

• Focused history to collect important data including symptoms like chest pain
• Family history of high blood pressure
• Medical history of co-existing conditions like diabetes
• Physical examination
• Blood tests
• Electrocardiogram
• Echocardiogram or ultrasound of the heart

The doctor or nurse will ask the patient if he or she has ever been told they have high blood pressure; if high blood pressure runs in their family; what medications they are taking (certain prescription drugs and over-the-counter medicines can cause hypertension); if they have experienced symptoms such as sweating, palpitations, headaches, dizziness, or weight loss (which can suggest a glandular cause or, rarely, a tumor); and if there are other medical conditions.

During the physical examination, the doctor usually checks the blood pressure in both arms (rare conditions produce different blood pressures in each arm); feels the thyroid gland in the neck to see if it is enlarged or nodular; listens to the heart for "extra" heart sounds; and listens over the neck, abdomen, and groin area for sounds created by turbulent blood flow through diseased or blocked arteries. The health care specialist may also take a careful look at the back of the eyes with an ophthalmoscope, examining the small blood vessels for signs of damage from chronic high blood pressure.

Several blood tests are usually performed to check for evidence of kidney dysfunction, which can cause high blood pressure, and abnormal mineral levels, which may suggest glandular problems. An electrocardiogram (ECG) is often obtained to determine whether the heart walls or chambers are thickening or becoming enlarged as a result of chronic, untreated hypertension, or whether a person has previously suffered a heart attack (myocardial infarction).

High Blood Pressure (Hypertension), Diagnosis reprinted with permission from cardiologychannel.com
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