Evaluation of Hypertension

The evaluation of patients with resistant hypertension should be directed toward confirming true treatment resistance; identification of causes contributing to treatment resistance, including secondary causes of hypertension; and documentation of target-organ damage. Accurate assessment of treatment adherence and use of good blood pressure measurement technique is required to exclude pseudo resistance. In most cases, treatment resistance is multifactorial in etiology with obesity, excessive dietary sodium intake, obstructive sleep apnea, and CKD being particularly common factors.

Target-organ damage such as retinopathy, CKD, and LVH supports a diagnosis of poorly controlled hypertension and in the case of CKD will influence treatment in terms of classes of agents selected as well as establishing a blood pressure goal of <130/80 mm Hg. Most patients who present with elevated blood pressure (BP) will have essential (idiopathic) hypertension; extensive laboratory evaluation for secondary causes in these patients is low-yield and cost-prohibitive. However, identification of a secondary cause may often lead to a cure of the elevated BP or to a decrease in the number and/or doses of antihypertensive agents and a reduction in the long-term cardiovascular risks of hypertension.

  • ELISA for AAAR and cardiac myosin
  • Laboratory tests for the investigation
  • Endocrine or hormonal regulation of BP
  • Diagnostic imaging modalities
  • Interventional cardiology
  • Teleradiology

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