Is the Recommended Work-Up Adequate.

For initial evaluation of newly diagnosed hypertension, work-up aims to answer three questions: 1) Is there a potentially reversible (secondary) cause; 2) What is the extent of target organ damage; and 3) What other risk factors are present. Routine work-up should include an adequate history and physical examination and these laboratory tests: hematocrit, urine analysis, blood fasting glucose, potassium, creatinine, total cholesterol and HDL-cholesterol and an electrocardiogram. Some would include a plasma renin profile, uric acid and calcium. If evidences for secondary causes are found on the routine work-up, appropriate additional tests are indicated. The 3 presentations that follow address the place of out-of-the-office blood pressure monitoring which I believe should always be obtained if possible. Another procedure that may be more frequently indicated is echocardiography. For now, cost constraints will limit echo to ascertainment of suspected coexistent cardiac disease or left ventricular hypertrophy when ECG findings or blood pressure levels are discrepant with other clinical features. A less expensive, limited echo could be more easily justified. An exercise stress test cannot be recommended although the blood pressure response may provide useful prognostic information.