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Circulation, Vol 79, 721-731, Copyright © 1989 by American Heart Association

ARTICLES

Office evaluation of hypertension. A statement for health professionals by a writing group of the Council for High Blood Pressure Research, American Heart Association

RW Gifford Jr, W Kirkendall, DT O'Connor and W Weidman
American Heart Association, Office of Scientific Affairs, Dallas, TX 75231.

The ultimate purpose of office evaluation of the hypertensive patient is to provide optimal management of blood pressure and associated risk factors. The workup includes a valid estimate of average blood pressure, including home blood pressure measurements, assessment of the degree of target organ damage, and identification of other risk factors, including family history. The history and physical examination should be directed to the principal target organs, including the optic fundi, central nervous system, heart, and kidneys. Laboratory evaluation should include urinalysis, ECG, and determinations of blood hemoglobin/hematocrit, creatinine, potassium, glucose, and cholesterol, including HDL fraction. This information will alert the physician to the possibility of curable forms of hypertension such as coarctation of the aorta, pheochromocytoma, primary aldosteronism, and renovascular hypertension. The office evaluation is also concerned with estimating prognosis and extent of organic damage, which is essential in planning management. The nurse or trained allied health professional should be used to the fullest possible extent both in evaluation and management of hypertensive patients.

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