Blood tests in hypertension diagnosis
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Blood Pressure Measurement Methods in Hypertension Diagnosis
Accurate blood pressure (BP) measurement is the foundation of hypertension diagnosis. Office blood pressure measurement (OBPM) remains the most commonly used method in primary care, but it is often performed incompletely, with most diagnoses based on only one or two readings instead of the recommended three or more. This incomplete approach can lead to misdiagnosis and inappropriate treatment decisions, highlighting the need for improvement in measurement practices . The 2017 US guidelines and recent studies emphasize the importance of confirming BP levels with out-of-office measurements, such as home BP monitoring (HBPM) or 24-hour ambulatory BP monitoring (ABPM), to address issues like white-coat and masked hypertension and to improve diagnostic accuracy 39. Patients also report that methods involving repeated measurements, such as HBPM and ABPM, provide a better understanding of BP variability and are perceived as more accurate, though ABPM can be uncomfortable .
Role of Blood Tests in Hypertension Diagnosis and Monitoring
Blood tests play a crucial role in the initial evaluation and ongoing monitoring of hypertension. The main goals are to detect secondary causes, assess organ damage, and identify comorbid conditions that may influence management 68. Evidence supports the routine use of estimated glomerular filtration rate (eGFR) to detect chronic kidney disease and hemoglobin A1c (HbA1c) to screen for diabetes in adults with hypertension . Other commonly ordered tests, such as lipids, electrolytes, hemoglobin, thyroid function, and liver function tests, have inconsistent or limited evidence supporting their routine use in all hypertensive patients . The frequency and type of laboratory abnormalities detected are higher in older patients and those with multiple comorbidities, suggesting that testing should be tailored to individual risk profiles .
Specialized Biochemical and Hematological Markers
Beyond routine blood tests, specialized biochemical investigations are important for identifying secondary hypertension, such as primary aldosteronism, where the aldosterone-to-renin ratio is a key screening tool 68. New hematological parameters, including the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-HDL ratio (MHR), and red cell distribution width (RDW), are being studied for their potential to predict hypertension and its complications. These markers are inexpensive and easily obtained, offering promise for early screening and risk stratification, though their use is not yet standard practice .
Practical Considerations and Recommendations
While OBPM is still the most widely used diagnostic method, its limitations and the benefits of out-of-office measurements are clear. Implementing standardized protocols for BP measurement and increasing the use of HBPM and ABPM can improve diagnostic accuracy and patient understanding 35710. For blood tests, focusing on those with strong evidence—such as eGFR and HbA1c—can reduce unnecessary testing and associated harms, while further research is needed to clarify the role of other tests and determine optimal testing frequency .
Conclusion
Diagnosing hypertension accurately requires both reliable BP measurement methods and targeted blood tests. Out-of-office BP monitoring and evidence-based laboratory testing, particularly for kidney function and diabetes, are essential for optimal care. Tailoring testing to patient risk factors and improving measurement practices in primary care can enhance diagnosis, reduce unnecessary interventions, and improve outcomes for people with hypertension 12345678+2 MORE.
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